The vulnerable sites and protection of pelvic autonomic nerve in total mesorectal excision of rectal cancer

Abstract

Total mesorecal excision (TME) is considered as the standard procedure for rectal cancer worldwide. With the popularization and cognition of TME procedure, the pelvic autonomic nerves preservation (PANP) in the operation is valued gradually. We considered there are six areas which are easily injured in the TME procedure: inferior mesorectal plexus (IMP) at the root of inferior mesorectal artery (IMA), superior hypogastric plexus (SHP) and the proximal part of hypogastric plexus (HP), proximal part of anterior branches of pelvic plexus, main trunk of posterior branches of pelvic plexus, terminal part of posterior branches of pelvic plexus, pelvic splanchnic nerves. Familiarity with the anatomy of pelvic fascia and autonomic nerves, development of TME plane dominated and pelvic autonomic nerves guided precise rectal cancer surgery play an important role in promoting the quality of surgery and protecting the function of organ. Key words: Rectal neoplasms; Total mesorecal excision; Pelvic autonomic nerves preservation