scholarly journals Three-dimensional anatomy of the Denonvilliers’ fascia after micro-CT reconstruction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seung Yoon Yang ◽  
Ho Seung Kim ◽  
Min Soo Cho ◽  
Nam Kyu Kim
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Three Dimensional ◽  
Ct Images ◽  
Seminal Vesicles ◽  
Oncologic Outcomes ◽  
Autonomic Nerves ◽  
Micro Ct ◽  
Ct Reconstruction ◽  
Mesorectal Excision

AbstractAn understanding of the anatomy of the Denonvilliers’ fascia is essential for successful surgical outcomes for patients with rectal cancer in the mid- to lower regions, especially near the seminal vesicles and prostate in males. Whether the correct surgical plane during a total mesorectal excision should be anterior or posterior to the Denonvilliers’ fascia is currently under debate. This study aimed to investigate the Denonvilliers’ fascia using micro-computed tomography (micro-CT) to acquire three-dimensional images nondestructively for assessments of the relationship between the Denonvilliers’ fascia, the mesorectal fascia, and neurovascular bundles to elucidate the correct anterior total mesorectal excision plane. Eight specimens were obtained bilaterally from four fresh human cadavers. Four specimens were stained with phosphotungstic acid to visualize the soft tissue, and micro-CT images were obtained; the other four specimens were stained with Masson’s trichrome to visualize connective tissue. Micro-CT images corroborate that the Denonvilliers’ fascia consists of a multilayered structure that separates the rectum from the seminal vesicles and the prostate. Specimens stained with Masson’s trichrome showed that the urogenital neurovascular bundle located at the posterolateral corner of the prostate is separated from the mesorectum by the Denonvilliers’ fascia. For the preservation of autonomic nerves necessary for urogenital function and optimal oncologic outcomes in patients with rectal cancer, a successful mesorectal excision requires a dissection plane posterior to the Denonvilliers’ fascia.

10-Year Oncologic Outcomes After Laparoscopic or Open Total Mesorectal Excision for Rectal Cancer

2016 ◽  
Vol 40 (12) ◽  
pp. 3052-3062 ◽  
Author(s):  
Marco E. Allaix ◽  
Giuseppe Giraudo ◽  
Alessia Ferrarese ◽  
Alberto Arezzo ◽  
Fabrizio Rebecchi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Oncologic Outcomes ◽  
Mesorectal Excision

scholarly journals Is There Any Reason Not to Perform Standard Laparoscopic Total Mesorectal Excision?

2017 ◽  
Vol 30 (05) ◽  
pp. 333-338 ◽  
Author(s):  
Zaher Lakkis ◽  
Yves Panis
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Randomized Clinical Trials ◽  
Current Knowledge ◽  
Locally Advanced ◽  
Rectal Surgery ◽  
Advanced Rectal Cancer ◽  
Oncologic Outcomes ◽  
Mesorectal Excision ◽  
Laparoscopic Tme

AbstractThe curative treatment of locally advanced rectal cancer is currently based on chemoradiotherapy and total mesorectal excision (TME). Laparoscopy has developed considerably because of obvious clinical benefits such as reduced pain and shorter hospital stay. Recently, several prospective randomized clinical trials with long-term follow-up have showed that laparoscopy is noninferior to laparotomy with the same oncologic outcomes in terms of survival and local control rate. However, laparoscopic TME remains a challenging procedure requiring a high level of expertise and a long learning curve to ensure an adequate and safe resection. The only relative contraindication of laparoscopic rectal surgery is T4 rectal cancer extended beyond the plane of TME. In this situation, it is reasonable to consider an open resection to avoid an uncomplete resection. In obese and elderly patients, laparoscopic TME also provides the same benefits as in nonobese and younger patients but may be more difficult to achieve. This review summarizes current knowledge on the place of laparoscopic TME in the treatment of rectal cancer.

scholarly journals Transanal total mesorectal excision for rectal cancer: a multicentric cohort study

2019 ◽  
Vol 8 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Liang Kang ◽  
Yuan-Guang Chen ◽  
Hao Zhang ◽  
Hong-Yu Zhang ◽  
Guo-Le Lin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Survival Rates ◽  
Operating Time ◽  
Disease Free Survival ◽  
Oncologic Outcomes ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Kaplan Meier

Abstract Background Transanal total mesorectal excision (taTME) has recently emerged as a promising novel surgical procedure for rectal cancer. It is believed to hold the potential advantage of providing better access to mobilize the distal rectum and achieving better pathologic results. This study aimed to evaluate the feasibility of taTME for rectal cancer and summarize the preliminary experience in 10 Chinese hospitals. Methods A total of 211 patients were enrolled in this study. Variables for evaluation of safety, feasibility, and oncologic outcomes were retrospectively collected and analysed. Results The median distance between the tumor and the anal verge was 5.9 cm (range, 1.5–12 cm). The median operating time was 280 min (range, 70–600 min) and the median estimated intra-operative blood loss was 50 mL (range, 10–1,500 mL). The overall rate of complication was 27.9%. Among the 211 patients, 175 (82.9%) had complete TME and 33 (15.6%) had near complete TME. The circumferential resection margin was negative in 97.7% of patients. The patients were followed for a median of 35 months (range, 2–86 months). There was 7.6% (16) mortality, 6.2% (13) had local recurrence, and 12.8% (27) had systemic recurrence. Kaplan–Meier survival analysis showed that 1-, 2-, and 3-year disease-free survival rates were 94.8%, 89.3%, and 80.2%, respectively, and 1-, 2-, and 3-year OS rates were 97.4%, 95.7%, and 92.9%, respectively. Conclusions Although limited by its retrospective nature, taTME was safe and feasible in selected patients. Future work with rigorous data recording is warranted.

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