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Pelican Cancer Foundation, The Ark, Dinwoodie Drive, Basingstoke, Hampshire, RG24 9NN
Telephone 01256 314 746
www.pelicancancer.org
Information regarding your Transanal TME operation, and the data we would like to
collect from it
Your consultant has recommended that you have an operation to remove part of the bowel
called the rectum, which is located low down in your pelvis. This operation is sometimes
referred to as a TME, or total mesorectal excision. Traditionally, this operation has been done
through a cut in the tummy wall, or abdomen. More recently, techniques such as keyhole
surgery (inserting surgical tools through small cuts in the abdomen) have been developed
which may allow faster recovery with smaller scars. Both open and keyhole surgery require
you to have a general anaesthetic.
Both these methods can be tricky when operating low down in the pelvis, as the view the
surgeon has can be limited. Your surgeon has suggested a new approach to removing the
rectum. This is called a transanal approach. In this technique, special surgical tools are
introduced through the anus (back passage), whilst you are asleep. These tools are used to
free the rectum up from its surroundings so that it can be removed. The advantage of this
technique is that the surgeon has a much better view during this procedure than the view
given by traditional or keyhole TME surgery alone. Transanal surgery is, however, usually
carried out in combination with traditional or keyhole surgery, as this is necessary to free the
bowel higher up. This allows the rectum to be removed, and then if possible, the bowel rejoined at the end of the operation.
It is thought that the better views given by the transanal approach may help make the surgery
easier and safer. Specifically, the rectum sits near to some important nerves, which help
control our bladder and sexual function. It is possible that these nerves can get damaged in
TME surgery. Whilst the surgeon is always careful in trying not to damage these nerves, it is
a recognised complication of TME surgery which is mentioned to patients in the process of
informed consent. This may be partly due to the limited view given by traditional and
keyhole TME surgery through the abdomen. It is thought that the transanal approach may
help better protect these nerves from damage during TME surgery, due to the clearer views
obtained.
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This technique is still quite new, and we don’t have any data over a long period of time, that
can tell us if the transanal approach is indeed better than traditional or keyhole TME surgery.
Therefore we would like to collect data on the outcomes of people having transanal surgery,
to see if we can answer this question. The data collected will all be part of routine care for
TME surgery, with a few specific details about each patient. Such details include age, any
treatments or medications (both past and present) that may be important, details of the disease
in the rectum itself, and any complications that arise after the surgery. No identifiable data
such as your name or address will be stored. Your own surgeon will be able to access this
data about you, in the same way as reading your medical notes, but no-one else will be able to
do so. The database is located in an approved secure website, which meets all security
requirements.
Your surgeon will explain the specifics of the operation to you personally, as these will
depend on the individual details of your condition. The operation may involve making a
stoma, where part of the bowel is brought out through the abdominal wall (tummy) to empty
into a bag. Your surgeon will talk to you about this in some detail if necessary, often with a
specialist nurse.
You will be asked to sign a consent form for the operation, which explains the nature of the
surgery, along with any side effects or risks associated with it. Your surgeon will go through
everything in detail with you before you sign. You should also be asked directly about
allowing your information about this operation to be entered onto the database for research
purposes.
You are free to choose whether or not you consent to the use of your operation details in this
way. Either way, it will not affect the care that you receive during your time in hospital.
It is hoped that this information sheet explains, in some detail, about what we hope to achieve
with this research. If you have any questions about the content, please ask the doctor or nurse
who are looking after you.
Thank you for your time.
Steven Arnold
Consultant Colorectal Surgeon & Lead Researcher
Version 2.0 July 2015