TME trial

Background

The Basingstoke District Hospital (UK) referred all rectal cancer patients to a single surgical team. This landmark single-center, single-surgeon case series reports 115 patients with Dukes A, B, or C rectal adenocarcinoma who underwent the then-novel total mesorectal excision (TME), a sharp dissection along the embryologic plane to remove the rectum with its surrounding mesorectal envelope intact.

Interventions and follow up

Treatment: Total mesorectal excision (TME) with sharp dissection of the mesorectal plane; adjuvant chemotherapy and/or radiation offered only to selected high-risk patients
Design: Single-arm, prospective case series (no randomized control arm)
Primary endpoint: Local recurrence rate
mFollow up: NR (5-yr outcomes reported)

Results

5-yr OS: 87%
5-yr tumor-free survival by Dukes stage: A 94%, B 87%, C 58%
5-yr cumulative local recurrence rate: 3.7% (vs historical reported rates of 30–40%)

Adverse events

Surgical: Anastomotic leak and pelvic complications reported; not quantified by grading system (NR)
Mortality: No operative mortality emphasized in the series (NR)

Conclusions

Foundational study that introduced total mesorectal excision, demonstrating that meticulous sharp dissection of the mesorectal plane dramatically reduces local recurrence in rectal cancer.

Key Limitations

Single-surgeon, single-center, non-randomized case series; comparison to historical controls only; small sample (n=115); selective use of adjuvant therapy limits generalizability.

Clinical Context

TME became the global surgical standard for rectal cancer and underpins all modern multimodality rectal cancer therapy. Endorsed in ESMO and ASCO rectal cancer guidance; subsequent trials (e.g., Dutch TME, MRC CR07) studied radiotherapy added to TME.

References