American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred surgical procedure for treating rectal cancer?

1. Colostomy

2. Local excision

3. Total mesorectal excision

4. Proctectomy

The correct answer is: Total mesorectal excision

The preferred surgical procedure for treating rectal cancer is total mesorectal excision (TME). This technique involves the complete removal of the rectum along with the surrounding mesorectal tissue, which contains lymphatic and vascular supply to the rectum. By excising the entire mesorectum, the procedure aims to ensure that any cancerous cells within that tissue are removed, reducing the risk of local recurrence. TME is particularly important in rectal cancer due to the close proximity of tumors to vital structures, and it has been shown to improve outcomes in terms of both cancer control and overall survival. Other surgical options have their particular contexts and indications but do not provide the same level of comprehensive treatment for rectal cancer. For instance, local excision is typically reserved for very early-stage tumors due to the risk of leaving residual cancer behind. Proctectomy refers to the removal of the rectum but may not necessarily include adequate resection of the mesorectum, which is critical for tumor control. A colostomy, while sometimes necessary, is not a treatment for the cancer itself but rather a management option for complications or end-stage disease. Thus, total mesorectal excision is the most effective and preferred method in the