Kraima, AC, West, NP, Treanor, D et al. (5 more authors) (2015) Whole mount microscopic sections reveal that Denonvilliers' fascia is one entity and adherent to the mesorectal fascia; Implications for the anterior plane in total mesorectal excision? European Journal of Surgical Oncology, 41 (6). 738 - 745. ISSN 0748-7983
Abstract
Background Excellent anatomical knowledge of the rectum and surrounding structures is essential for total mesorectal excision (TME). Denonviliers' fascia (DVF) has been frequently studied, though the optimal anterior plane in TME is still disputed. The relationship of the lateral edges of DVF to the autonomic nerves and mesorectal fascia is unclear. We studied whole mout microscopic sections of en-bloc cadaveric pelvic exenteration and describe implications for TME. Methods Four donated human adult cadaveric specimens (two males, two females) were obtained from the Leeds GIFT Research Tissue Programme. Paraffin-embedded mega blocks were produced and serially sectioned at 50 and 250 μm intervals. Sections were stained with haematoxylin & eosin, Masson's trichrome and Millers' elastin. Additionally, a series of eleven human fetal specimens (embryonic age of 9-20 weeks) were studied. Results DVF consisted of multiple fascial condensations of collagen and smooth muscle fibres and was indistinguishable from the anterior mesorectal fascia and the prostatic fascia or posterior vaginal wall. The lateral edges of DVF appeared fan-shaped and the most posterior part was continuous with the mesorectal fascia. Fasciae were not identified in fetal specimens. Conclusion DVF is adherent to and continuous with the mesorectal fascia. Optimal surgical dissection during TME should be carried out anterior to DVF to ensure radical removal, particularly for anterior tumours. Autonomic nerves are at risk, but can be preserved by closely following the mesorectal fascia along the anterolateral mesorectum. The lack of evident fasciae in fetal specimens suggested that these might be formed in later developmental stages.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2015, Elsevier. This is an author produced version of a paper published in European Journal of Surgical Oncology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Total mesorectal excision; Denonvilliers' fascia; Rectal cancer; Mesorectal fascia; Autonomic nerves |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Engineering & Physical Sciences (Leeds) > School of Computing (Leeds) > Artificial Intelligence & Biological Systems (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 09 Oct 2015 11:20 |
Last Modified: | 09 Apr 2016 03:29 |
Published Version: | http://dx.doi.org/10.1016/j.ejso.2015.03.224 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.ejso.2015.03.224 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:89125 |