Abstract

Worldwide, colorectal cancer is the third most common cancer and one of the leading causes of cancer-related deaths. Currently, total mesorectal excision (TME) is considered as the gold standard surgical procedure for rectal cancer. To achieve a good oncologic outcome and functional outcome after TME in distal rectal cancer, exact knowledge regarding the pelvic anatomy including pelvic fascia, pelvic floor, and the autonomic nerve is essential. Accurate TME along the embryologic plane not only reduces local recurrence rate but also preserves urinary and sexual function by minimizing nerve damage. In the past, pelvic floor muscles and autonomic nerves could not be visualized clearly, however, the development of imaging studies and improvements of minimally invasive surgical techniques such as laparoscopic and robotic surgery can clearly show the anatomy of the pelvic region. In this chapter, we will provide accurate anatomy of the rectum and the anal canal, pelvic fascia, and the pelvic autonomic nerve. This anatomical information will be an important indicator for performing an adequate operation for distal rectal cancer.

Highlights

  • Colorectal cancer is the third most common cancer and the fourth leading cause of cancer-related deaths worldwide [1]

  • The fundamental principle of total mesorectal excision (TME) is en bloc resection of the rectum with its surrounding fatty tissue complex which contains the blood vessels and lymphatics down to the pelvic floor

  • The rectum is surrounded by a fatty tissue complex called the mesorectum, which contains abundant blood vessels, lymphatics, and lymph nodes

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Summary

Introduction

Colorectal cancer is the third most common cancer and the fourth leading cause of cancer-related deaths worldwide [1]. Rectal cancer accounts for 30–40% of colorectal cancer, and the treatment strategy is different and more complicated compared to colon cancer because of its anatomical features. The treatment outcome of rectal cancer has greatly improved with the development of multimodality treatment including neoadjuvant radiotherapy, cytotoxic chemotherapy, and target agents, surgery remains the mainstay of therapy. Since the concept of total mesorectal excision (TME) was first described by Richard Heald in 1979, this procedure became the gold standard technique for rectal cancer surgery until now [2]. To achieve complete TME and sphincter preserving surgery in low-lying rectal cancer, knowledge for regarding the pelvic fascia (mesorectal, parietal) and autonomic nerves, a thorough understanding of the pelvic floor anatomy is essential

Basic anatomy of the rectum and mesorectum
Fascia structures around the rectum
Fascia propria of the rectum and presacral fascia
Anal canal
Pelvic floor
Anococcygeal ligaments
Pelvic autonomic nerve system
Superior hypogastric plexus and hypogastric nerves
Pelvic splanchnic nerves
Conclusion

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