title: A new technique to achieve sufficient mesorectal excision in upper rectal cancer.
abstract: BACKGROUND
  Appropriate partial mesorectal excision (PME) is extremely important for prevention of local recurrence even in upper rectal cancer. However, it is not always easy to conduct PME in the narrow pelvic cavity. We devised a new surgical technique that involves a rectal transection followed by PME.
  
  
  METHODS
  After rectal mobilization in the layer targeted for total mesorectal excision, only the rectal wall was bluntly dissected at an appropriate distance from the tumor. Initial transection of the rectum allows drawing the rectum toward the anal side so that the mesorectum can be confirmed with a good visual field. Excision of the mesorectum was easy, and it could be resected in a short time.
  
  
  RESULTS
  This technique was conducted on seven patients with upper rectal cancer and on four patients with rectosigmoid cancer. Separation of the rectal wall was comparatively easy, and we had no incidence of wall injury. The average distance from the rectal stump to the distal mesorectum in the freshly resected specimen was 15 mm, indicating satisfactory PME.
  
  
  CONCLUSIONS
  This easily performed method is a promising procedure for achieving sufficient PME in upper rectal cancer.
authors.affiliation: Department of Surgery, St. Luke's International Hospital, Tokyo, Japan. ohsei@luke.or.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohigashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Hayashi
authors.forename: Gen
authors.initials: G
authors.lastname: Shimada
authors.forename: Hisashi
authors.initials: H
authors.lastname: Onodera
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*