Kraima, AC, West, NP, Treanor, D et al. (6 more authors) (2015) Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves. EJSO - European Journal of Surgical Oncology, 41 (12). pp. 1621-1629. ISSN 0748-7983
Abstract
Aim: Excellent understanding of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, fasciae anterolateral to the rectum and surrounding the low rectum are still poorly understood. We studied the perirectal fascia enfolding the extraperitoneally located part of the rectum in en-bloc cadaveric specimens and the University Medical Center Utrecht (UMCU) pelvic dataset, and describe implications for TME. Methods: Four donated human adult cadaveric specimens (two males, two females) were obtained through the Leeds GIFT Research Tissue Programme. Paraffin-embedded blocks were produced and serially sectioned at 50 and 250 μm intervals. Whole mount sections were stained with haematoxylin & eosin, Masson's trichrome and Millers' elastin. Additionally, the UMCU pelvic dataset including digitalised cryosections of a female pelvis in three axes was studied. Results: The mid and lower rectum were surrounded by a multi-layered perirectal fascia, of which the mesorectal fascia (MRF) and parietal fascia bordered the ‘holy plane’. There was no extra constant fascia forming a potential surgical plane. Nerves ran laterally to the MRF. More caudally, the mesorectal fat strongly reduced and the MRF approached the rectal muscularis propria. The MRF had a variable appearance in terms of thickness and completeness, most prominently at the anterolateral lower rectum. Conclusion: Dissection onto the MRF allows nerve preservation in TME. Rectal surgeons are challenged in doing so as the MRF varies in thickness and shows gaps, most prominently at the anterolateral lower rectum. At this site, the risk of entering the mesorectum is great and may result in an incomplete specimen.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2015, Elsevier Ltd. 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; Pairectal fascia; Mesorectal fascia; Autonomic nerves; Rectal cancer |
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: | 15 Feb 2016 11:32 |
Last Modified: | 16 Nov 2016 08:26 |
Published Version: | http://dx.doi.org/10.1016/j.ejso.2015.08.166 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.ejso.2015.08.166 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:94080 |