Reconsideration of the anterior surgical plane of total mesorectal excision for rectal cancer
Diseases of the Colon and Rectum Apr 17, 2019
Fang J, et al. - Researchers undertook this cadaveric study mainly focusing on the anatomy of Denonvilliers’ fascia, in order to examine the relationship between Denonvilliers’ fascia and rectum. For mid-low rectal cancer, dissection of the peritoneum was performed at the lowest level of peritoneal reflection, instead of dissection 1 cm above peritoneal reflection, during laparoscopic resection in practice. Dissection of 4 cases of cadavers revealed loose tissues between Denonvilliers’ fascia and rectal specimen suggesting the existence of a surgical plane posterior to Denonvilliers’ fascia. They recommend reconsidering the anterior surgical plane for total mesorectal excision and suggest the feasibility and practicability for performing dissection posterior to Denonvilliers’ fascia for patients without risk of positive anterior circumferential resection margin.
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