Extrafascial excision of the rectum for rectal cancer

The fascia propria of the rectum is an upward capsular projection from the superior fascia of the pelvic floor which surrounds the rectum and its mesorectum posteriorly and the fat, blood vessels, nerves and lymphatics in front and laterally. It is postulated that if rectal cancer is contained within the fascia propria and extrafascial excision of the rectum is performed then it would be exceptional for the cancer to recur locally.

A total of 122 consecutive patients with rectal cancer underwent extrafascial excision of the rectum. The operation involved mobilizing the rectum outside its fascia propria and removing not only the rectum and its mesorectum posteriorly but also the fat, blood vessels, nerves and lymphatics in front and laterally. Resection was considered curative unless there were distant metastases or the tumour had involved the resection margins.

There was one postoperative death. The cumulative cancer-free survival rate at 5 years was 68 per cent. In 100 patients in whom the operation was considered to be curative, the cumulative cancer-free survival rate was 81 per cent. Eighty-four of these patients were available for a minimum follow-up of 24 (median 73, range 24-193) months. Three (4 per cent) developed local recurrence. In two patients this was at the anastomosis.

If the cancer is contained within the fascial tube surrounding the rectum and complete extrafascial excision has been performed, local recurrence will be minimal.