This is the clinical guidebook for rectal cancer in BC, providing a lot of information. Some things to clarify with my doctors within it: [BC Cancer Management Manual-Gastrointestinal Cancer-Rectum](http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-manual/gastrointestinal/rectum#Primary-Surgical-Therapy-rectum) ### Surgery For upper rectal tumours, a 5cm proximal and distal resection margin is standard (anterior resection), with en bloc lymphadenectomy (achieved by resecting the mesorectum to the distal rectal margin) and removal of all clinically suspicious lymph nodes outside the field of resection. Primary anastomosis is performed. [BC Cancer Management Manual-Gastrointestinal Cancer-Rectum-Surgery](http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-manual/gastrointestinal/rectum#Primary-Surgical-Therapy-rectum) Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. This is a decision tree on considering surgery:  ### Other surgery reference notes: The standard surgical procedures used to remove Stage III rectal cancer include low anterior resection (LAR) or abdominoperineal resection (APR). The choice of operation depends on the location of the rectal cancer. An LAR involves an incision across the abdomen and removal of the cancerous part of the rectum along with some surrounding tissue and lymph nodes. The circumferential margin of resection (CRM) is the plane where surgeons must dissect in order to perform a standardised total mesorectal excision [MRI of rectal cancer—relevant anatomy and staging key points | Insights into Imaging | Full Text](https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00890-7) Total mesorectal excision (TME) is a standard surgical technique for treatment of rectal cancer. It is a precise dissection of the mesorectal envelope comprising rectum containing the tumour together with all the surrounding fatty tissue and the sheet of tissue that contains lymph nodes and blood vessels. Dissection is along the avascular alveolar plane between the presacral and mesorectal fascia, described as holy plane (Heald's "holy plane").[3] Dissection along this plane facilitates a straightforward dissection and preserves the sacral vessels and hypogastric nerves and is a sphincter-sparing resection and decreases permanent stoma rates. It is possible to rejoin the two ends of the colon; however, most patients require a temporary ileostomy pouch to bypass the colon, allowing it to heal with less risk of infection, perforation or leakage. [Total mesorectal excision - Wikipedia](https://en.wikipedia.org/wiki/Total_mesorectal_excision) TME has become the "gold standard" treatment for rectal cancer Worldwide