New classification system for radical rectal cancer surgery based on membrane anatomy

Area of Science:

• Surgical Anatomy
• Oncology
• Pelvic Surgery

Background:

• Total mesorectal excision (TME) along the "holy plane" is standard for rectal cancer.
• Alternative fascial planes around the rectum exist for radical resection.

Purpose of the Study:

• To propose a novel membrane anatomical and staging-oriented classification for rectal cancer surgery.
• To tailor surgical radicality based on detailed pelvic anatomy.

Main Methods:

• Established a 3D pelvic membrane anatomy template.
• Clarified anatomical nomenclature via cadaveric dissection and laparoscopic observation.
• Developed a simplified classification based on lateral resection extent.

Main Results:

• Identified three distinct fascial spaces (medial, middle, lateral) around the rectum.
• Described three types of radical rectal cancer surgery (A, B, C) corresponding to these spaces.
• Demonstrated precise anatomical positioning of vessels and nerves within these spaces and planes.

Conclusions:

• A classification system based on membrane anatomy precisely defines three radical surgical types, including nerve-sparing options.
• This system provides an optimal tool for tailoring rectal cancer surgery based on anatomical planes.