Autonomic nerve preserving total mesorectal excision

Total mesorectal excision (TME) is precise dissection outside the visceral fascia that envelops the mesorectum. It yields a complete resection of all regional cancer, characterized by a smooth specimen and a denuded pelvic cavity. Most rectal cancers have not spread beyond the mesorectum at time of presentation; thus excision of an intact mesorecturn provides optimal surgical treatment. Local control and survival after TME are excellent. Traditionally, rectal cancer surgery is associated with a serious risk to sexual and urinary function. During TME, it has been our deliberate effort to identify and preserve the pelvic autonomic nerves. This article reviews the history, the anatomical foundation, the surgical technique, and the functional results achieved by total mesorectal excision with autonomic nerve preservation (TME-ANP).