Lymph node dissection in rectal carcinoma: TME and what else?

Total mesorectal excision (TME) has been established as a standardized radical surgical procedure in malignant tumors of the middle and lower rectal third. In carcinomas of the upper rectal third, TME is seen as controversial. The aims of TME are low rates of locoregional recurrences and good functional results. Total mesorectal excision in the radical surgical treatment of lower and middle third rectal carcinomas is the essential part of lymphatic dissection in these tumors. It will be discussed if additional procedures are relevant for lymph node dissection, and how far they are established and approved. As yet, the results of laparoscopic TME show no advantage over conventional TME. The quality of TME should be assessed by a pathologist according to predefined criteria. In multimodal treatment regimens, TME is also essential.