[Anatomic basis of function-preserving operation for low rectal cancer]

Area of Science:

• Anatomy
• Surgical Oncology
• Neuroscience

Context:

• Total mesorectal excision (TME) is the standard surgical procedure for rectal cancer.
• Sexual and urinary dysfunction are known complications following TME.
• Understanding the anatomical relationship between the surgical plane and pelvic autonomic nerves is crucial for minimizing these adverse effects.

Purpose:

• To define the precise surgical plane for TME through cadaver dissections.
• To elucidate the relationship between the TME surgical plane and the pelvic autonomic nervous system.
• To differentiate between aggregated and diffused shapes of the pelvic plexus and their proximity to visceral fascia.

Summary:

• Cadaver dissections were performed to identify the optimal surgical plane for TME.
• The study mapped the pelvic autonomic nerves in relation to this plane.
• It was observed that the diffused type of pelvic plexus is intimately associated with visceral fascia, posing challenges for sharp dissection.

Impact:

• Provides anatomical clarity to reduce the risk of sexual and urinary dysfunction after TME.
• Highlights the need for further investigation into the functional roles of different pelvic plexus units.
• Aims to improve surgical techniques for rectal cancer to preserve autonomic nerve function.