Extramesorectal Excision (EME) for posterior tumors with threatened circumferential resection margins

Taha Sheikh, Slawomir Marecik, MD, George Melich, Joaquin Estrada, MD, John Park, Prasad Leela. Advocate Lutheran general Hospital

Purpose: This video presents a concept of the Extramesorectal Excision (EME), which involves rectal resection performed in the wider plane than the traditional mesorectal excision. This is particularly important in the patients with threatened radial margins.

Methods: A robotic platform was used to perform TME and EME in the difficult male pelvis with a large tumor encroaching on the radial margin of resection. Special attention was given to identify the necessary reference points while venturing through the extramesorectal plane.

Results: All details of the operation are shown. The successful clearance around the tumor was achieved. The final specimen was demonstrated.

Conclusions: Extramesorectal Excision is feasible and safe but it requires expertise in rectal resection. It has a potential to improve the oncologic results of rectal cancer surgery. It can be combined with the minimally invasive techniques like the one provided by the robotic platform.

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