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Surgical Techniques in Rectal Cancer pp 125–146Cite as

Surgical Anatomy of the Rectum

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Abstract

The goal of infraperitoneal rectal resection for cancer is complete mesorectal excision, including the rectal visceral fascia that envelops the mesorectum (with “extra-fascial” excision), with lymphadenectomy of the inferior mesenteric lymphatic drainage system. If the proper plane of dissection is respected, this also guarantees preservation of genitourinary function by sparing the autonomic innervation of the detrusor muscles, the smooth muscle urethral sphincter, the glandular and smooth muscle components of the vaginal wall, and the erectile bodies. While the oncologic goal of surgery for rectal cancer is complete removal of all tumoral tissues, it is also important to spare the nerves, in women as well as in men. There is risk of nerve injury throughout the procedure. Dissection must be guided by the planes of the perirectal fascia, the so-called “nerve guardians” of the pelvis. Detailed knowledge of the anatomy of the rectum and its fascial relationships is one major prerequisite for both accurate diagnostic imaging and successful treatment.

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Authors and Affiliations

  1. Service de Chirurgie Digestive, Oncologique et Métabolique, Hôpital Ambroise-Paré, AP—HP, 9, Avenue Charles-de-Gaulle, 92104, Boulogne-Billancourt, France

    David Moszkowicz M.D., Ph.D

  2. UVSQ/Université Paris Saclay, UFR des Sciences de la Santé Simone-Veil, 2 Avenue de la Source de la Bièvre, 78180, Montigny-Le-Bretonneux, France

    David Moszkowicz M.D., Ph.D

  3. Département de Chirurgie Digestive, Oncologique et Métabolique, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France

    David Fuks M.D., Ph.D & Brice Gayet M.D., Ph.D

  4. UFR Paris Descartes, Paris, France

    David Fuks M.D., Ph.D & Brice Gayet M.D., Ph.D

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  1. David Moszkowicz M.D., Ph.D
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  2. David Fuks M.D., Ph.D
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  3. Brice Gayet M.D., Ph.D
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Correspondence to Brice Gayet M.D., Ph.D .

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Editors and Affiliations

  1. Saint-Pierre University Hospital, Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Brussels, Belgium

    Giovanni Dapri

  2. Minimally Invasive Colorectal Surgery, Lankenau Medical Center, Main Line Healthcare, Wynnewood, Pennsylvania, USA

    John H Marks

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Moszkowicz, D., Fuks, D., Gayet, B. (2018). Surgical Anatomy of the Rectum. In: Dapri, G., Marks, J. (eds) Surgical Techniques in Rectal Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55579-7_8

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  • DOI: https://doi.org/10.1007/978-4-431-55579-7_8

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