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Updated: Jul 21, 2025
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
[Reappraisal of the lateral mesorectum and its clinical importance]
1Department of Colorectal Surgery, First Affiliated Hospital of the Navy Medical University, Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai 200433, China.
Abstract:
The mesentery has been defined as a double fold of the peritoneum connecting some regions of the intestine to the posterior abdominal wall. It emerges from the superior mesenteric root region and fans out to span the intestine from the duodenum to the rectum. The mesorectal is a continuation of the intraperitoneal mesentery in the pelvic cavity. The lateral structure of the rectum is complex and the traditional view calls it the lateral ligament of the rectal. However, this structure could be called the lateral mesorectum from the perspective of embryonic development and membrane anatomy. The lateral mesorectum is the bridge of the vessels, lymphatic, and nerves between the rectum and the pelvic wall. It anchors the rectum to the lateral pelvic wall and is the anatomical basis of lateral lymph node metastasis in low rectal cancer. Meanwhile, it is important to identify the lateral mesorectum and its surrounding structure to radically resect the tumor and protect the pelvic autonomic nerve during the total mesorectal excision procedure.
Insights
The lateral mesorectum, a peritoneal fold, connects the rectum to the pelvic wall. Understanding this structure is crucial for rectal cancer surgery and nerve preservation.
Area of Science:
- Anatomy
- Surgical Oncology
- Embryology
Background:
- The mesentery is a peritoneal fold connecting intestines to the abdominal wall.
- The mesorectal is a continuation of the mesentery in the pelvic cavity.
- The lateral rectal structure, traditionally termed the lateral ligament of the rectum, is re-conceptualized as the lateral mesorectum.
Purpose of the Study:
- To propose the term "lateral mesorectum" based on embryological and membrane anatomy.
- To highlight the anatomical and surgical significance of the lateral mesorectum.
- To emphasize its role in rectal cancer metastasis and surgical procedures.
Main Methods:
- Review of anatomical and embryological literature.
- Comparative analysis of traditional and proposed terminology.
- Correlation with surgical implications in total mesorectal excision.
Main Results:
- The lateral mesorectum serves as a conduit for vessels, lymphatics, and nerves between the rectum and pelvic wall.
- It anchors the rectum to the lateral pelvic wall.
- It represents the anatomical basis for lateral lymph node metastasis in low rectal cancer.
Conclusions:
- The lateral mesorectum is a critical structure for understanding rectal cancer spread.
- Accurate identification of the lateral mesorectum is vital for radical tumor resection.
- Preservation of pelvic autonomic nerves during surgery relies on precise knowledge of this anatomy.
