Defining the surgical planes on MRI improves surgery for cancer of the low rectum

Cancer of the low rectum provides a challenge for both preoperative staging and optimum operative management. Current outcomes for patients with low rectal cancer are poor, particularly for those treated by abdominoperineal excision. It has been suggested that this poor outcome is due to an inherent oncological inferiority of the traditional abdominoperineal excision procedure, which might be explained by the unique anatomical features of the low rectum and the lack of clearly defined anatomical excision planes. In this Personal View, we discuss the anatomical and surgical planes available for the management of low rectal cancer, and describe the two-plane approach to low rectal cancer using the mesorectal plane and the extralevator plane.