Mesenteric-based colorectal surgery

The terms CME and TME cannot be precisely defined. Similarly, non-CME and non-TME or conventional surgery cannot be precisely defined and rigorous comparisons between both types are not possible. In contrast, the terms mesenteric and non-mesenteric based can be defined. Notwithstanding this, clinical trials proving efficacy of one standard over another are not ethical and thus will not be conducted. In this context, future resources may be best directed toward further consolidating the standardization (rather than proving the supremacy of) mesenteric-based surgery. Numerous international programs have already achieved this in relation to TME. The non-mesenteric standard of colorectal surgery cannot be universally reproduced because it is not anatomic based. The mesenteric-based standard can be universally reproduced because it is founded on universally applicable principles (anatomic, histologic, physiologic), which are described in the first half of this book. The second half describes how surgeons adopt these principles to reproducibly achieve the standard of mesenteric-based colorectal surgery. The second half thus serves as a surgical foundation by which the principles of mesenteric-based surgery can be universally taught and thus achieved.