Rectal cancer. Operative improvement by anatomical knowledge with special reference to the mesorectum

The connective tissue spaces of the pelvis and pelvic floor originate from an urogenital and perirectal mesenchymal cell complex, which can be clearly discerned. In the adult, the final compartments, which arise from these di stinct tissue complexes, are still functionally separated. The perirectal t issue gives rise to the rectal fascia or rectal adventitia, also known as m esorectum. The connective tissue space between rectal and parietal pelvic f ascia can be dissected as a plane free of vessels and nerves. Surgical diss ection along this plane with complete mesorectum excision results in reliab le excision of all relevant lymphatic pathways with extensive preservation of continence and sexual function.