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Optimal Complete Rectum Mobilization Focused on the Anatomy of the Pelvic Fascia and Autonomic Nerves: 30 Years of Experience at Severance Hospital

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초록

The primary goal of surgery for rectal cancer is to achieve an oncologically safe resection, i.e., a radical resection with a sufficient safe margin. Total mesorectal excision has been introduced for radical surgery of rectal cancer and has yielded greatly improved oncologic outcomes in terms of local recurrence and cancer-specific survival. Along with oncologic outcomes, functional outcomes, such as voiding and sexual function, have also been emphasized in patients undergoing rectal cancer surgery to improve quality of life. Intraoperative nerve damage or combined excision is the primary reason for sexual and urinary dysfunction. In the past, these forms of damage could be attributed to the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerve. With the adoption of minimally invasive surgery, visualization of nerve structure and meticulous dissection for the mesorectum are now possible. As the leading hospital employing this technique, we have adopted minimally invasive platforms (laparoscopy, robot-assisted surgery) in the field of rectal cancer surgery and standardized this technique globally. Here, we review a standardized technique for rectal cancer surgery based on our experience at Severance Hospital, suggest some practical technical tips, and discuss a couple of debatable issues in this field.

Abstract

The primary goal of surgery for rectal cancer is to achieve an oncologically safe resection, i.e., a radical resection with a sufficient safe margin. Total mesorectal excision has been introduced for radical surgery of rectal cancer and has yielded greatly improved oncologic outcomes in terms of local recurrence and cancer-specific survival. Along with oncologic outcomes, functional outcomes, such as voiding and sexual function, have also been emphasized in patients undergoing rectal cancer surgery to improve quality of life. Intraoperative nerve damage or combined excision is the primary reason for sexual and urinary dysfunction. In the past, these forms of damage could be attributed to the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerve. With the adoption of minimally invasive surgery, visualization of nerve structure and meticulous dissection for the mesorectum are now possible. As the leading hospital employing this technique, we have adopted minimally invasive platforms (laparoscopy, robot-assisted surgery) in the field of rectal cancer surgery and standardized this technique globally. Here, we review a standardized technique for rectal cancer surgery based on our experience at Severance Hospital, suggest some practical technical tips, and discuss a couple of debatable issues in this field.

참고문헌 (61)

  1. Chew MH, "Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades", Gastroenterol Rep(Oxf), 4, pp.173~185 (2016)
  2. Bokey EL, "Local recurrence after curative excision of the rectum for cancer without adjuvant therapy : role of total anatomical dissection", Br J Surg, 86, pp.1164~1170 (1999)
  3. 김남규, "Anatomic Basis of Sharp Pelvic Dissection for Curative Resection of Rectal Cancer", Yonsei Medical Journal, 46(6), pp.737~749 (2005), 연세대학교의과대학
  4. Heald RJ, "A new approach to rectal cancer", Br J Hosp Med, 22, pp.277~281 (1979)
  5. Piso P, "Total mesorectal excision for middle and lower rectal cancer : a single institution experience with 337 consecutive patients", J Surg Oncol, 86, pp.115~121 (2004)
  6. Hill GL, "Extrafascial excision of the rectum for rectal cancer", Br J Surg, 85, pp.809~812 (1998)
  7. Delibegovic S, "Introduction to total mesorectal excision", Med Arch, 71, pp.434~438 (2017)
  8. Heald RJ, "The perfect total mesorectal excision obviates the need for anything else in the management of most rectal cancers", Clin Colon Rectal Surg, 30, pp.324~332 (2017)
  9. Jayne DG, "Randomized trial of laparoscopic-assisted resection of colorectal carcinoma : 3-year results of the UK MRC CLASICC Trial Group", J Clin Oncol, 25, pp.3061~3068 (2007)
  10. van der Pas MH, "Laparoscopic versus open surgery for rectal cancer(COLOR II) : short-term outcomes of a randomised, phase 3 trial", Lancet Oncol, 14, pp.210~218 (2013)
  11. Kang SB, "Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy(COREAN trial) : short-term outcomes of an open-label randomised controlled trial", Lancet Oncol, 11, pp.637~645 (2010)
  12. Fleshman J, "Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer : follow-up results of the ACOSOG Z6051 randomized controlled trial", Ann Surg, 269, pp.589~595 (2019)
  13. Stevenson ARL, "Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer : the Australasian laparoscopic cancer of the rectum randomized clinical trial", Ann Surg, 269, pp.596~602 (2019)
  14. Jayne D, "Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial", JAMA, 318, pp.1569~1580 (2017)
  15. Luca F, "Sexual and urinary outcomes in robotic rectal surgery : review of the literature and technical considerations", Updates Surg, 70, pp.415~421 (2018)
  16. Hur H, "Comparative study of voiding and male sexual function following open and laparoscopic total mesorectal excision in patients with rectal cancer", J Surg Oncol, 108, pp.572~578 (2013)
  17. Kim JY, "A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer : laparoscopic versus robotic surgery", Ann Surg Oncol, 19, pp.2485~2493 (2012)
  18. Kim HS, "Long-term voiding and sexual function in male patients after robotic total mesorectal excision with autonomic nerve preservation for rectal cancer : a cross-sectional study", Surg Laparosc Endosc Percutan Tech, 30, pp.137~143 (2020)
  19. Wang G, "Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer", Int J Med Robot, 13, pp.e1725~ (2017)
  20. Kim NK, "Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer", Dis Colon Rectum, 45, pp.1178~1185 (2002)
  21. Maurer CA, "Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery", Br J Surg, 88, pp.1501~1505 (2001)
  22. Nagawa H, "Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy", Dis Colon Rectum, 44, pp.1274~1280 (2001)
  23. Pocard M, "A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer", Surgery, 131, pp.368~372 (2002)
  24. 이종민, "Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings", Annals of Coloproctolgy, 34(2), pp.59~71 (2018), 대한대장항문학회
  25. Kraima AC, "Understanding the surgical pitfalls in total mesorectal excision : investigating the histology of the perirectal fascia and the pelvic autonomic nerves", Eur J Surg Oncol, 41, pp.1621~1629 (2015)
  26. Bissett IP, "Extrafascial excision of the rectum for cancer : a technique for the avoidance of the complications of rectal mobilization", Semin Surg Oncol, 18, pp.207~215 (2000)
  27. Crapp AR, "William Waldeyer and the rectosacral fascia", Surg Gynecol Obstet, 138, pp.252~256 (1974)
  28. Kraima AC, "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?", Eur J Surg Oncol, 41, pp.738~745 (2015)
  29. Nagpal K, "Colorectal surgery and its impact on male sexual function", Curr Urol Rep, 14, pp.279~284 (2013)
  30. Kinugasa Y, "Histological identification of fascial structures posterolateral to the rectum", Br J Surg, 94, pp.620~626 (2007)
  31. Walsh PC, "Radical pelvic surgery with preservation of sexual function", Ann Surg, 208, pp.391~400 (1988)
  32. Kim NK, "Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation : expert technical tips for robotic surgery", Surg Oncol, 24, pp.172~180 (2015)
  33. Stoker J, "Anorectal and pelvic floor anatomy", Best Pract Res Clin Gastroenterol, 23, pp.463~475 (2009)
  34. Kim NK, "Surgical treatment of colorectal cancer: Asian perspectives on optimization and standardization" (2018), Springer Nature Singapore PTE Ltd
  35. Heald RJ, "The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?", Br J Surg, 69, pp.613~616 (1982)
  36. Kinugasa Y, "Development of the human hypogastric nerve sheath with special reference to the topohistology between the nerve sheath and other prevertebral fascial structures", Clin Anat, 21, pp.558~567 (2008)
  37. Lange MM, "Level of arterial ligation in rectal cancer surgery : low tie preferred over high tie. A review", Dis Colon Rectum, 51, pp.1139~1145 (2008)
  38. Mohammed A. AlSuhaimi, "Operative safety and oncologic outcomes in rectal cancer based on the level of inferior mesenteric artery ligation: a stratified analysis of a large Korean cohort", Annals of Surgical Treatment and Research, 97(5), pp.254~260 (2019), 대한외과학회[DOI]
  39. Sami F. AL-Asari, "The Relation between Inferior Mesenteric Vein Ligation and Collateral Vessels to Splenic Flexure: Anatomical Landmarks, Technical Precautions and Clinical Significance", Yonsei Medical Journal, 54(6), pp.1484~1490 (2013), 연세대학교의과대학[DOI]
  40. Asari SA, "Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer : a narrative review and outcomes study from an expert tertiary center", Eur J Surg Oncol, 41, pp.175~185 (2015)
  41. Chapuis P, "Mobilization of the rectum : anatomic concepts and the bookshelf revisited", Dis Colon Rectum, 45, pp.1~8 (2002)
  42. Moszkowicz D, "Where does pelvic nerve injury occur during rectal surgery for cancer?", Colorectal Dis, 13, pp.1326~1334 (2011)
  43. Diop M, ""Mesorectum" : the surgical value of an anatomical approach", Surg Radiol Anat, 25, pp.290~304 (2003)
  44. Quinn MJ, "Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon(Br J Surg 2000;87 : 1288-99)", Br J Surg, 88, pp.888~ (2001)
  45. Kim NK, "Anatomic basis of sharp pelvic dissection for total mesorectal excision with pelvic autonomic nerve preservation for rectal cancer", J Korean Soc Coloproctol, 20, pp.424~433 (2004)
  46. García-Armengol J, "Review of the anatomic concepts in relation to the retrorectal space and endopelvic fascia : Waldeyer’s fascia and the rectosacral fascia", Colorectal Dis, 10, pp.298~302 (2008)
  47. Heald RJ, "Embryology and anatomy of the rectum", Semin Surg Oncol, 15, pp.66~71 (1998)
  48. Sagar PM, "Surgery of the colon and rectum", pp.1~18 (1997), Churchill Livingstone
  49. Kinugasa Y, "Anatomical reevaluation of the anococcygeal ligament and its surgical relevance", Dis Colon Rectum, 54, pp.232~237 (2011)
  50. Church JM, "The surgical anatomy of the rectum--a review with particular relevance to the hazards of rectal mobilisation", Int J Colorectal Dis, 2, pp.158~166 (1987)
  51. Ghareeb WM, "The ‘multilayer’ theory of Denonvilliers’ fascia : anatomical dissection of cadavers with the aim to improve neurovascular bundle preservation during rectal mobilization", Colorectal Dis, 22, pp.195~202 (2020)
  52. Xu Z, "Denonvilliers’ fascia in men : a sheet plastination and confocal microscopy study of the prerectal space and the presence of an optimal anterior plane when mobilizing the rectum for cancer", Colorectal Dis, 20, pp.236~242 (2018)
  53. Lindsey I, "Iatrogenic impotence and rectal dissection", Br J Surg, 89, pp.1493~1494 (2002)
  54. Peschaud F, "Preservation of genital innervation in women during total mesorectal excision: which anterior plane?", World J Surg, 36, pp.201~207 (2012)
  55. Fang J, "Reconsideration of the anterior surgical plane of total mesorectal excision for rectal cancer", Dis Colon Rectum, 62, pp.639~641 (2019)
  56. Zhang C, "Perirectal fascia and spaces : annular distribution pattern around the mesorectum", Dis Colon Rectum, 53, pp.1315~1322 (2010)
  57. Jones OM, "Lateral ligaments of the rectum : an anatomical study", Br J Surg, 86, pp.487~489 (1999)
  58. Tamakawa M, "Fascial structures and autonomic nerves in the female pelvis : a study using macroscopic slices and their corresponding histology", Anat Sci Int, 78, pp.228~242 (2003)
  59. Sato K, "The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia", Surg Radiol Anat, 13, pp.17~22 (1991)
  60. Kiyomatsu T, "Anatomy of the middle rectal artery : a review of the historical literature", Surg Today, 47, pp.14~19 (2017)
  61. Lin M, "The anatomy of lateral ligament of the rectum and its role in total mesorectal excision", World J Surg, 34, pp.594~598 (2010)

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