Identificantion and application of surgical pelvic nerve anatomy in rectal cancer with regards to laparoscopic radical resection

Abstract

The advent of total mesorectal excision (TME) together with minimally invasive techniques such as laparoscopic mid-low rectal cancer surgery has improved in term of OS and decreased the local recurrence rate. However, the incidence of urinary and sexual dysfunction remains high, which affects the patient′s quality of life. Although the above function is influenced by several factors including age, preoperative sexual function, psychological factors, and concurrent chemoradiation, intraoperative nerve damage is the primary reason for sexual and urinary dysfunction and occurs mainly because of the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerves. Therefore, understanding the anatomical landmarks is the basis for protecting nerve function of laparoscopic surgery for rectal cancer. In this review, we illustrate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle, superior hypogastric plexus, inferior hypogastric plexus, pelvic splanchnic nerves, neurovascular bundles and provide a theoretical basis and reference for the protection of pelvic autonomic nerve function. Key words: Rectal neoplasms; Total mesorectal excision; Pelvic autonomic nerve preservation; Urinary dysfunction; Sexual dysfunction