The mesorectum and total mesorectal excision (TME): role of the pathologist in judging the completeness and quality of mesorectal excision

Introduction The best way to optimize rectal cancer patient care is by a multidisciplinary team approach, including a surgeon, a radiologist, a pathologist, a gastroenterologist, a radiotherapist, and a medical oncologist. This leads to significant improvements in the outcome of rectal cancer treatment.1 However, it is a prerequisite that all members of the different medical disciplines of the team have sufficient background knowledge of imaging, pathology, treatment modalities, and prognostic factors of this disease. This review focuses on the gross pathology of rectal cancer, with description of the mesorectum, and includes some digital images of rectal cancer resection specimens. In addition, an overview is given of microscopic features that are important for determination of further management and prognosis of rectal cancer, and the benefit of pathological report forms e.g. as proposed by the Belgian PROCARE working group (multidisciplinary Belgian PROject on CAncer of the REctum) is emphasized.2