What Are the Main Features of a TME?
A. TME represents a classical milestone in the history of cancer surgery because it was the first tissue block to be defined for cancer whose boundaries are conceptually and practically founded in a basic science –embryology, and now its offspring–ontogenetics. Unexpectedly massive improvement in local recurrence rates followed the application of the mere idea of TME to surgical practice–albeit imperfectly implemented in the early stages. This pointed to a fundamental truth now recognized as relevant to all visceral cancers – that embryologically defined envelopes of tissue with surgical and MRI definable margins and recognizably shiny surfaces present the careful surgeon with particular opportunities for cure–implying that the primary spread of carcinoma is often contained within these envelopes. These same margins provide the basis for modern image guidance from MRI scanning, not only in planning for surgery, but in modern radiotherapy (RT) as well. (Image guided Intensity modulated and volume modulated arc therapy - IGIMRT & VMAT) Furthermore respect for the surrounding layers and the understanding of their anatomy, in both surgery and radiotherapy, has a major potential, not only for more actual “cures” but also for the preservation of the important autonomic functions of the surrounding nerve plexuses. These can be grouped together as “Pelvic Happiness”–sexual functions, continence Etc. – without which quality of life becomes seriously diminished and which continue to be diminished by anything less than the highest standards of surgical technique.