Total mesorectal excision with autonomic serve preservation: a new foundation for the evaluation of multi-disciplinary adjuvant therapy in the management of rectal cancers

Local and distant recurrence rates and disease-free and overall survival ar e markedly improved by total mesorectal excision, with little increase in m orbidity, compared with other techniques of resection of rectal cancer. Adj uvant therapy is associated with significant morbidity and initial results suggest it may not be beneficial in the aggregate. Adjuvant therapy must be re-evaluated in trials using TME as standard operative technique. Differen t subgroups of patients, defined by clinical and pathological criteria will be best served by different forms of therapy and should be studied based o n rates of local and distant recurrence. Selected groups of patients will b e best served by undergoing no adjuvant therapy of any kind.