Extrafascial excision of the rectum for cancer: A technique for the avoidance of the complications of rectal mobilization

Serious complications can occur following mobilization of the rectum for ca ncer including: ureteric injury, rectal perforation, hemorrhage, autonomic nerve damage, and local recurrence of the tumor in the pelvis. Each of thes e complications can be minimized by careful dissection in correct tissue pl anes in the pelvis. The rectum and mesorectum are surrounded by the fascia propria, a thin fascial envelope. This envelope offers a surface for dissec tion that leads the surgeon to a safe plane lying inside the autonomic nerv es, the ureter, and the presacral vessels, and lying outside of the mesorec tum and its associated vessels and lymphatics. The surgical anatomy of the pelvis is presented, with emphasis on the rectal fascia propria, as a basis for a detailed description of the technique of extrafascial excision of th e rectum. Semin. Surg, Oncol. 18:207-215, 2000, (C) 2000 Wiley-Liss, Inc.