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COLORECTAL ONCOLOGY
Colorectal Cancer Resection (TME)
Precision surgery for colorectal and rectal cancer — total mesorectal excision (TME) achieves complete removal of rectal cancer within its fascial envelope, dramatically reducing local recurrence rates.
ABOUT THE PROCEDURE
The Surgical Standard for Rectal Cancer — TME Technique
Total Mesorectal Excision (TME) is the gold standard surgical technique for rectal cancer, developed by Prof. Bill Heald and now universally adopted. The technique involves sharp dissection in the embryological plane between the fascia propria of the rectum and the pelvic fascia, removing the rectum along with its entire mesorectal envelope — containing lymph nodes, blood vessels, and potentially microscopic tumour deposits.
This precise technique has reduced local recurrence rates in rectal cancer from >30% to <5% in high-volume centres. A laparoscopic or robotic-assisted approach allows equivalent oncological results with improved short-term outcomes in skilled hands. Sphincter-preserving resection is achieved in the majority of patients even with low rectal tumours.
For colon cancer, formal right hemicolectomy, left hemicolectomy, or sigmoid colectomy with high ligation of the vascular pedicle and adequate lymph node harvest (≥12 nodes) is the standard of care, increasingly performed laparoscopically.
How It Is Performed
Staging & MDT Planning
High-resolution MRI pelvis for rectal cancer staging, CT for colon cancer. Neoadjuvant chemoradiotherapy for T3-T4 or node-positive rectal cancer (SCRT or long-course CRT).
Mesorectal Dissection (TME)
Sharp dissection in the holy plane under direct vision. The rectum and its mesorectal envelope are removed intact — a “complete TME” is the oncological goal.
Sphincter Assessment & Reconstruction
If ≥1cm distal margin is achievable and sphincters are functional, an intersphincteric resection or low anterior resection with colo-anal anastomosis preserves continence.
Defunctioning Stoma & Follow-up
Temporary loop ileostomy protects the anastomosis. Closed at 8–12 weeks after anastomotic integrity confirmed. Oncology surveillance with CEA and CT every 6 months.
CANDIDACY
Who May Benefit?
Rectal adenocarcinoma (T1–T4)
All stages of rectal cancer require specialist surgical evaluation. T3/T4 or node-positive disease receives neoadjuvant therapy first, then TME surgery.
Colon cancer without distant metastases
Stages I–III colon cancer is primarily managed with upfront surgery followed by adjuvant FOLFOX chemotherapy for stage III disease.
Colon cancer with resectable liver metastases
Synchronous liver metastases in colorectal cancer may be resected simultaneously or in staged fashion — coordinated by the surgical oncologist.
Hereditary colorectal cancer syndromes
FAP or Lynch syndrome patients may require prophylactic or therapeutic total colectomy with ileorectal or ileo-anal pouch anastomosis.
AIIMS TRAINING · COLORECTAL
Colorectal Oncological Surgery from AIIMS
Dr. Imaduddin trained extensively in colorectal oncological surgery including TME for rectal cancer at AIIMS, and has co-authored published randomised trial data relevant to colorectal cancer surgery.
Get Expert Consultation for Colorectal Cancer Surgery
Colorectal cancer surgery outcomes depend significantly on surgical technique and volume. Dr. Imaduddin provides specialist colorectal oncology consultations in Hyderabad.