Standardization of laparoscopic total mesorectal excision for rectal cancer: A structured international expert consensus

Danilo Miskovic, Jake Foster, Ayman Agha, Conor P. Delaney, Nader Francis, Hirotoshi Hasegawa, Alexey Karachun, Seon Hahn Kim, Wai Lun Law, John Marks, Mario Morino, Yves Panis, Juan Carlos Patrón Uriburu, Steven D. Wexner, Amjad Parvaiz

Research output: Contribution to journalArticlepeer-review

65 Citations (Scopus)


Objective: To establish a structured international expert consensus on a detailed technical description of the laparoscopic total mesorectal excision (TME). Background: Laparoscopic TME is a common surgical approach for the treatment of rectal cancer, but there is little agreement on technical details and standards. Methods: Sixty leading surgical experts from 5 different world regions with a median overall experience of 250 laparoscopic TME participated in this study. Four stages of mixed quantitative and qualitative consensus-finding methods were applied. (1) Semistructured expert interviews were independently analyzed by 2 assessors. (2) Consensus on the interview data was reached using reiterating questionnaires (Delphi method). (3) This was further refined in an interactive workshop. (4) Based on this meeting, a comprehensive text was drafted and final approval was sought by all experts. Findings: Three theme categories were identified in 9 detailed interviews (anatomical landmarks, description of tissue retraction, and operating strategies). Following 2 rounds of a 54-item questionnaire, 29 items achieved very high agreement (A∗ ≥90%), 14 with good agreement (≥80%), 13 with moderate agreement (≥50%), and 18 with little or no agreement (<50%). In the workshop, areas of agreement were consolidated and conclusions were sought for those with less agreement. The final document was approved after 2 further rounds of surveys by all respondents. Conclusions: This detailed and agreed technical description of laparoscopic TME may have implications on training, assessment, quality control, and future research.

Original languageEnglish
Pages (from-to)716-722
Number of pages7
JournalAnnals of surgery
Issue number4
Publication statusPublished - 2015 Apr
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.


  • Colorectal surgery
  • Consensus
  • Expert
  • Laparoscopic
  • Rectal cancer
  • Total mesorectal excision

ASJC Scopus subject areas

  • Surgery


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