From TEM to TME: Comment on “No-Scar Transanal Total Mesorectal Excision”

Leroy and colleagues¹ report their exceptional achievement in providing for a patient with rectal neoplasia an oncologically packaged TME entirely via a pure natural orifice (transanal, transrectal) approach. While the ultimate pathology proved benign (and so meaning that a more conventional intraluminal microsurgical/endoscopic resection would also have conferred a cure in this particular instance), Leroy and colleagues have studiously developed an operative strategy whose realization is more than just a potential additional niche in our therapeutic armamentarium for mid- to low-rectal tumors. Their implicit separation of the mesorectal excision component from the mesocolic lymphadenectomy inherent to the standard transabdominal operation (whatever the access) may also portend an era of stratified resective extent for colorectal cancer individualized by preoperative staging and molecular profiling.