The surgery for total rectal mesentery resection m
Not long ago, Professor Bernard Nordlinger, Chief Surgeon of Ambroise Pare Hospital, Paris, Chairman of Gastroenterology, the European Tumor Research and Treatment Organization was invited by the Beijing Oncology Hospital to present a lecture on the subject of Total Mesenteric Resection (TMR) and to demonstrate the actual procedure. Professors Gu Jin and Ji Jia et al of Beijing Oncology Hospital considered that the minor details of the operation demonstrated by Professor Nordlinger were very much worthwhile for the domestic colleagues to learn and that the ideal operative effect could be obtained only by setting up a strict standardization of surgical procedure.
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As was recommended, TMR has the advantages of being able to decrease the postoperative recurrence rate of rectal cancer and to improve the survival rate and quality of life of the patient. Consequently, TMR has witnessed an expanding role in the treatment of rectal cancer by the surgical circle all over the world in recent years. This operation was introduced into China in the 1990's, and in many hospitals this method was considered as the standard operative procedure for the treatment of rectal cancer over the middle and lower segments. However, due to insufficient specification of the operative procedure, the actual clinical outcome of the treatment was not as satisfactory as expected.
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TMR distinguishes itself from the conventional operative method chiefly in the following points. (1) Sharp dissection of the rectal mesentery along the non-vascular area between the splanchnic layer and pelvic fascia until complete isolation of the rectal mesentery and the rectum. (2) Encircling stripping of the rectal mesentery including the rectum and the tumor, with a resection of the rectal mesentery up to 5 cm distally or a total resection of the rectal mesentery. (3) Sharp dissection of the lateral rectal ligament, avoiding the use of clamping, scissors dissections or ligatures for the protection of pelvic nerve plexus.
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In spite of the advantages of TMR, there are some problems with the surgery as well: the requirement of a much lower anastomosis increases the likelihood of fistula occurrence at the stoma. Furthermore, the patient may have difficulty in control of the bowel movement after the operation.
Professor Nordlinger specially pointed out that TMR has certain degree of difficulties and only those surgeons who underwent strict training are allowed to perform this procedure. In the hospital where he works, the surgeons are only allowed to carry out TME until having completed conventional surgical procedures in more than 20 cases of rectal cancers. He considered that one of the key points for improvement of surgical outcomes is standardization of the surgical procedure., 百拇医药
, http://www.100md.com
As was recommended, TMR has the advantages of being able to decrease the postoperative recurrence rate of rectal cancer and to improve the survival rate and quality of life of the patient. Consequently, TMR has witnessed an expanding role in the treatment of rectal cancer by the surgical circle all over the world in recent years. This operation was introduced into China in the 1990's, and in many hospitals this method was considered as the standard operative procedure for the treatment of rectal cancer over the middle and lower segments. However, due to insufficient specification of the operative procedure, the actual clinical outcome of the treatment was not as satisfactory as expected.
, 百拇医药
TMR distinguishes itself from the conventional operative method chiefly in the following points. (1) Sharp dissection of the rectal mesentery along the non-vascular area between the splanchnic layer and pelvic fascia until complete isolation of the rectal mesentery and the rectum. (2) Encircling stripping of the rectal mesentery including the rectum and the tumor, with a resection of the rectal mesentery up to 5 cm distally or a total resection of the rectal mesentery. (3) Sharp dissection of the lateral rectal ligament, avoiding the use of clamping, scissors dissections or ligatures for the protection of pelvic nerve plexus.
, http://www.100md.com
In spite of the advantages of TMR, there are some problems with the surgery as well: the requirement of a much lower anastomosis increases the likelihood of fistula occurrence at the stoma. Furthermore, the patient may have difficulty in control of the bowel movement after the operation.
Professor Nordlinger specially pointed out that TMR has certain degree of difficulties and only those surgeons who underwent strict training are allowed to perform this procedure. In the hospital where he works, the surgeons are only allowed to carry out TME until having completed conventional surgical procedures in more than 20 cases of rectal cancers. He considered that one of the key points for improvement of surgical outcomes is standardization of the surgical procedure., 百拇医药