What is a total mesorectal excision?

This is the most commonly used operation to remove rectal cancer. The surgeon removes the part of the rectum that contains cancer, as well as some healthy tissue on either side. They also remove the fatty tissue (mesorectum) around the rectum, which contains blood vessels and lymph nodes. Removing the mesorectum reduces the risk of any cancer being left behind.

In the diagram below, the black dotted line shows an example of the tissue that may be removed during a TME operation. 

The large bowel and mesorectum

There are different types of TME operation. The type your surgeon recommends will depend on where the cancer is in your rectum, the size of the tumour and how far it is from the anus.

Anterior resection

An anterior resection is usually used for cancers in the upper and middle parts of the rectum (close to the colon).

After the piece of bowel that contains the cancer is removed, the surgeon rejoins the two open ends of bowel. The diagrams opposite show the part of the bowel that is removed, and how the two ends are joined together.

Some people may have a temporary stoma (usually an ileostomy) after this operation. A stoma reversal can usually be done a few months later.

Anterior resection – area to be removed

Anterior resection – area to be removed

Anterior resection – bowel has been rejoined

Anterior resection – bowel has been rejoined

Colo-anal and J pouch surgery

This operation may be used for tumours low in the rectum. The surgeon removes all of the rectum and attaches the colon to the anus. Sometimes, the surgeon makes a pouch (called a J pouch) from part of the colon, before joining it to the anus. The pouch acts like a new rectum and stores poo (stools) until it is convenient to pass them. The diagram below shows a J pouch.

You may have a temporary stoma (usually an ileostomy) after this operation. This allows the bowel to heal. A stoma reversal can usually be done a few months later.

J pouch surgery

Abdomino-perineal resection (APR)

This operation is usually used for cancers that are very low in the rectum (near to the anus). In order to remove all of the cancer, the surgeon needs to remove the rectum and anus. You will have a permanent stoma (usually an colostomy) after this operation.

As well as the wound on your tummy, you will have a wound on your bottom where the anus has been closed.

Abdomino-perineal resection – area to be removed

Abdomino-perineal resection – area to be removed

Permanent stoma formed after abdomino-perineal resection

Permanent stoma formed after abdomino-perineal resection

Colostomy bag outside the body

A stoma and colostomy bag

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