Total Mesorectal Excision: The Unrecognized Pelvic Plane

Total mesorectal excision for low rectal cancers has been shown to reduce local recurrence rate after curative operation to < 5 percent. The lack of anatomic appreciation of the mesorectum is an important cause of intersurgeon variability in the outcome of rectal cancer surgery. Surgical illustrations depicting the mesorectal anatomy, however, are less than accurate. Basic surgical concepts must be illustrated correctly to be learned correctly. True-to-life illustration is the only way the learner can appreciate the actual situation and improve his/her surgical results. We describe the mesorectal anatomy with correlation to computerized tomography scans of the in vivo rectum to further illustrate the technique of total mesorectal excision in rectal cancer surgery.