Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of General Surgery

Surgery is the main choice of treatment for patients with rectal cancer. The concept of total mesorectal excision (TME), which was introduced by (Heald and Ryall) during the 1980s has significantly improved the outcome for patients with rectal cancer, particularly with regard to local recurrence (Heald, et al., 2004). The local recurrence rates were reduced from between 30% and 40% to 5% after TME, Therefore TME has been generally accepted as the gold standard for rectal cancer surgery (Heald, et al., 1986). Exposure of the pelvic operative field could be a problem, because of narrow pelvis and impaired visibility as the dissection proceeds caudal. So, there are many problems with open TME surgery, mainly pertaining to difficulties in pelvic dissection leading to functional urogenital problems as bladder dysfunction occurs in 7-68%, especially in male patients (Lacy, et al., 2002). The introduction of laparoscopy into rectal cancer surgery has helped to get better visualization, more delicate instrumentationand better tissue handling. This in turn may lead to an adequate dissection up to the pelvic floor in combination with a better preservation of the hypo gastric plexus and nerves possibly resulting into good functional and oncological outcome. Laparoscopic total mesorectal excision (TME) with autonomic nerve preservation was reported to be feasible Nelson, et al., 2000

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