Kraima, AC, West, NP orcid.org/0000-0002-0346-6709, Roberts, N et al. (6 more authors) (2020) The role of the longitudinal muscle in the anal sphincter complex: Implications for the Intersphincteric Plane in Low Rectal Cancer Surgery? Clinical Anatomy, 33 (4). pp. 567-577. ISSN 0897-3806
Abstract
Intersphincteric resection (ISR) enables radical sphincter‐preserving surgery in a subset of low rectal tumors impinging on the anal sphincter complex (ASC). Excellent anatomical knowledge is essential for optimal ISR. This study describes the role of the longitudinal muscle (LM) in the ASC and implications for ISR and other low rectal and anal pathologies. Six human adult en bloc cadaveric specimens (three males, three females) were obtained from the University of Leeds GIFT Research Tissue Programme. Paraffin‐embedded mega blocks containing the ASC were produced and serially sectioned at 250 μm intervals. Whole mount microscopic sections were histologically stained and digitally scanned. The intersphincteric plane was shown to be potentially very variable. In some places adipose tissue is located between the external anal sphincter (EAS) and internal anal sphincter (IAS), whereas in others the LM interdigitates to obliterate the plane. Elsewhere the LM is (partly) absent with the intersphincteric plane lying on the IAS. The LM gave rise to the formation of the submucosae and corrugator ani muscles by penetrating the IAS and EAS. In four of six specimens, striated muscle fibers from the EAS curled around the distal IAS reaching the anal submucosa. The ASC formed a complex structure, varying between individuals with an inconstant LM affecting the potential location of the intersphincteric plane as well as a high degree of intermingling striated and smooth muscle fibers potentially further disrupting the plane. The complexity of identifying the correct pathological staging of low rectal cancer is also demonstrated.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 Wiley Periodicals, Inc. This is the peer reviewed version of the following article: Kraima, A.C., West, N.P., Roberts, N., Magee, D.R., Smit, N.N., van de Velde, C.J.H., DeRuiter, M.C., Rutten, H.J. and Quirke, P. (2020), The role of the longitudinal muscle in the anal sphincter complex. Clin Anat, 33: 567-577. doi:10.1002/ca.23444, which has been published in final form at https://doi.org/10.1002/ca.23444. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | longitudinal muscle; internal anal sphincter; external anal sphincter; anal sphincter complex; rectal cancer; intersphincteric resection; sphincter‐preserving surgery |
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) |
Funding Information: | Funder Grant number Yorkshire Cancer Research L386 |
Depositing User: | Symplectic Publications |
Date Deposited: | 20 Aug 2019 12:50 |
Last Modified: | 05 Aug 2020 00:38 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1002/ca.23444 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:149845 |