A 60-year-old man presents with haematochezia and a mobile, 3 cm rectal tumour 7 cm from the anal verge. MRI shows T2N1 disease with no CRM threat. He undergoes a low anterior resection. Which statement regarding total mesorectal excision (TME) is most accurate?

• A TME is only performed for upper rectal tumours above the peritoneal reflection
• B The hypogastric nerves are deliberately divided to achieve adequate lateral clearance in TME
• C TME involves blunt finger dissection to mobilise the mesorectum
• D TME involves sharp dissection in the avascular plane between the mesorectal fascia and parietal pelvic fascia ✓

Explanation

TME, as described by Heald, involves sharp dissection under direct vision in the holy plane between the visceral mesorectal fascia and the parietal pelvic fascia (Waldeyer's fascia). This produces an intact mesorectal envelope removing all lymph nodes en bloc, reducing local recurrence. The hypogastric plexus is carefully preserved, not divided. Blunt finger dissection violates the mesorectum and is not TME.

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.