Total Mesorectal Excision (TME), as defined in the ACOSOG Z6051, comprises of high ligation of IMA, splenic flexure takedown, transection of proximal left colon, dissection of the avascular plane in the pelvis, division of the lymphatics and middle hemorrhoidal vessels at the levators, and inclusion of pelvic fat and lympathic material to the level of the anorectal ring.
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