Planes of sharp pelvic dissection for primary, locally advanced, or recurrent rectal cancer

Abstract

In the design of operations for rectal cancers, the focus is often on circumventing the local extent of disease and leaving the pelvis free of cancer. The local extent of disease may range from minimal intramural invasion to the direct extension of a primary tumor to pelvic sidewall structures, e.g., the internal iliac vessels. In the absence of distant spread, understanding the planes of pelvic anatomy may allow the knowledgeable surgeon to cure patients who would otherwise be declared unresectable. We present the four planes (and one rare situation) available for sharp dissection which allow for the resection of all but a few cases of locally advanced disease. Semin. Surg. Oncol. 18:199–206, 2000. © 2000 Wiley‐Liss, Inc.

Adjuvant Chemotherapy Benefit in Elderly Stage II/III Colon Cancer Patients

“…However, it has recently been found that conventional colon surgery may not be sufficient when compared with standard surgery for rectal cancer (total mesorectal excision, TME) ( 17 – 19 ). Resection along the embryonic avascular mesorectal fascia plane could yield a complete specimen, including regional lymphatics, blood vessels, and surrounding adipose tissue bounded by the mesorectum ( 20 ). This could reduce the rate of local recurrence and improve disease-free and overall survival, and more research about this is needed in the future ( 21 ).…”

Important Points for Protection of the Autonomic Nerves During Total Mesorectal Excision

“…The first way damage can occur is extending outside the avascular plane between proper rectal fascia and presacral fascia (in other words, between the visceral and the parietal layers of the pelvic fascias). 14 The PPs, which are flattened and tangled with presacral fascia on the side wall of pelvis, are located very close to the rectal wall. 3,11,15 The connective tissue containing the autonomic fibers to the rectum, known as the lateral ligament of the rectum, makes following the avascular plane difficult.…”

Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer

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