الفهرس 
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Abstract
PURPOSE; To evaluate the role of total mesorectal excision in management of rectal cancer. MATERIALS AND METHODS: fifty patients presented with rectal cancer scheduled to undergo total mesorectal excision, as a main step of surgery in rectal cancer operation, either LAR or APR. All studied cases were operable and respectable, stage II and III without neoadjuvant therapy. Proper work up for all cases takes place. Results were analyzed statistically. RESULTS: The overall morbidity was 11 patients (22%), anastomotic leak (1 pt. of 13 cases of LAR)(7.7%), transient Bladder dysfunction had been reported in four patients (8%), local recurrence alone occurred in three (6%) patients, and distant metastasis alone occurred in 10 patients (20%) within the two years follow up, two (4%) patients had both local recurrence and distant metastasis. CONCLUSION: TME results in the lowest rates of local recurrence, a second benefit of TME is increased sparing of the anal sphincter, and the third benefit is that TME is a nerve-sparing dissection, less likely to lead to bladder and sexual dysfunction. More accurate preoperative imaging and staging methods will also contribute in tailoring treatments according to the patient’s characteristics. Further studies is necessary to ascertain the feasibility of the procedure in elderly patient, and the upper rectal cancer. KEY WORD; rectal cancer, total mesorectal excision, pelvic autonomic nerve preservation.