Surgical Anatomy of the Rectum

Chapter

Abstract

The goal of infraperitoneal rectal resection for cancer is complete mesorectal excision, including the rectal visceral fascia that envelops the mesorectum (with “extra-fascial” excision), with lymphadenectomy of the inferior mesenteric lymphatic drainage system. If the proper plane of dissection is respected, this also guarantees preservation of genitourinary function by sparing the autonomic innervation of the detrusor muscles, the smooth muscle urethral sphincter, the glandular and smooth muscle components of the vaginal wall, and the erectile bodies. While the oncologic goal of surgery for rectal cancer is complete removal of all tumoral tissues, it is also important to spare the nerves, in women as well as in men. There is risk of nerve injury throughout the procedure. Dissection must be guided by the planes of the perirectal fascia, the so-called “nerve guardians” of the pelvis. Detailed knowledge of the anatomy of the rectum and its fascial relationships is one major prerequisite for both accurate diagnostic imaging and successful treatment.

Keywords

Surgical anatomy Rectum Pelvic innervation 

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Copyright information

© Springer Japan 2018

Authors and Affiliations

  1. 1.Service de Chirurgie Digestive, Oncologique et Métabolique, Hôpital Ambroise-ParéBoulogne-BillancourtFrance
  2. 2.UVSQ/Université Paris Saclay, UFR des Sciences de la Santé Simone-VeilMontigny-Le-BretonneuxFrance
  3. 3.Département de Chirurgie Digestive, Oncologique et MétaboliqueInstitut Mutualiste Montsouris, Université Paris DescartesParisFrance
  4. 4.UFR Paris DescartesParisFrance

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