What Is the Anatomical Relationship of the Nerves in the Pelvis?
The pelvis is often considered to be a complex anatomical region. Due to the funnel-shaped pelvic cavity, there is a close anatomical relationship of the rectum to vital structures such as blood vessels, lymphatics and somatic and autonomic nerves. This, taken together with the relatively inaccessible location of the rectum, makes total mesorectal excision (TME) a challenging surgical procedure. The principles of TME surgery involve removal of the diseased rectum with the surrounding mesorectum as an en bloc specimen with an intact mesorectal fascia and preservation of the pelvic autonomic nerves . Over the last decades, both oncological and functional outcomes of TME surgery have gained much attention. It is well known that surgical disruption of the autonomic and somatic nerves may result in postoperative urogenital and anorectal dysfunction, affecting the patient’s functional outcome . If the oncological safety is not in danger, surgeons must preserve the autonomic and somatic nerves in order to warrant sufficient postoperative pelvic function.
- 5.Standring S (2008) Gray’s anatomy, 40th edn. Churchill Livingstone, LondonGoogle Scholar
- 9.Kraima AC, West NP, Treanor D et al (2015) Understanding the surgical pitfalls in total mesorectal excision: investigating the histology of the perirectal fascia and the pelvic autonomic nerves. Eur J Surg Oncol; in pressGoogle Scholar
- 20.Kraima AC, West NP, Treanor D et al (2015) The anatomy of the perineal body in relation to abdominoperineal excision for low rectal cancer. Eur J Surg Oncol 41(12):1621–1629Google Scholar
- 21.Wallner C, Lange MM, Bonsing BA et al (2008) Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: a study from the Cooperative Clinical Investigators of the Dutch total mesorectal excision trial. J Clin Oncol 26(27):4466–4472CrossRefPubMedGoogle Scholar