A 62-year-old man has a 4 cm adenocarcinoma of the mid-rectum. MRI shows T3 disease with the tumour invading the mesorectal fascia at one point. Which surgical plane during TME (total mesorectal excision) would reduce local recurrence most effectively?
- A Intersphincteric plane
- B Mesorectal plane (sharp dissection between mesorectal fascia and parietal pelvic fascia) ✓
- C Intramuscularis plane
- D Submucosal plane
Correct answer: B. Mesorectal plane (sharp dissection between mesorectal fascia and parietal pelvic fascia)
Explanation
Total mesorectal excision (TME) involves sharp dissection in the 'holy plane' — between the visceral mesorectal fascia and the parietal pelvic fascia — under direct vision. This ensures complete removal of the mesorectum and the CRM, reducing local recurrence from ~25% to <5%. Blunt dissection or straying into the mesorectum leads to positive margins and higher local recurrence.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.