The primacy of embryological, ontogenetic and specimen orientated (mesenteric) surgery as the most important tool in treating visceral (colorectal) cancer

Despite all the molecular markers, pharmaceutical innovations, genetic revolution and scientific advancement, surgery still remains the most effective way to cure visceral cancer. As all members of the Colorectal MDT know, chemotherapy is an adjunct to good quality surgery not a replacement, and radiotherapy does not absolve poor quality surgery. Despite this clear truth, most of the money, glamour, RCTs and attention are directed towards medical oncological advances and not surgical ones. Herein the author seeks to outline his reasoning for mesenteric based surgery along embryological, ontogenetic planes as the key factor in governing oncological outcome in the vast majority of cases; outline the fundamental concepts inherited from three surgical doyens, “3 H’s” of surgery—Heald, Holm and Hohenberger, and finally examine some data and reflect on the importance of case selection. This will start with the rectum (following TME principles) and build on from there.