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Abstract
The primary aims of rectal cancer surgery are to achieve oncological clearance of the tumor, to minimize local recurrence and to prolong survival. Accurate preoperative staging and precise surgical technique using the principles of total mesorectal excision (TME) are instrumental in achieving this goal. However, Quality of life must not be forgotten in the quest for oncological excellence.
Total mesorectal excision with pelvic autonomic nerve preservation (TME-ANP) has been reported to be an optimal surgery for rectal cancer. It minimizes local recurrence and sexual and urinary dysfunction. TME-ANP involves sharp dissection under direct vision in the avascular, areolar plane between the fascia propria of the rectum, which encompasses the mesorecum, and the parietal fascia overlying the pelvic wall structures. Post operative impotence, ejaculatory problems, or both are observed in 25-75% of conventionally treated patients compared with only 10-29% of patients after TME with its careful nerve sparing dissection.