Rectum and whole mesorectum
is completely mobilised, the sigmoid colon is transected with linear stapler and the specimen is removed through the perineal wound.
1,2) This may be explained by the anatomy of the distal rectum, which is covered by less mesorectum
, resulting in earlier tumour invasion of surrounding structures compared to the more proximal rectum.
is fat pad surrounding the rectum, and contains lymphatics and lymph nodes, separating it from surrounding structures even when tumour breeches the muscular layer.
He discussed in detail the quality of the mesorectum
why it is important and why should one do TME.
at the anastomosis site was removed up to the tunica muscularis recti.
sup] Because mesorectum
is a potential metastatic site for rectal cancer, total mesorectal excision (TME) has become the standard surgical intervention in LARC patients, which involves sharp dissection of rectosacral fascia, excision of rectum, and mesorectum
at the level of the levators.
Abdominal CT scan showed a large tumour (size 148/100/96 cm) involving the rectal stump, the bladder wall, prostate, mesorectum
and ileal small bowel loops (Fig.
Colorectal tumour deposits in the mesorectum
and pericolon; a critical review.
A TME involves removing the entire mesorectum
, without disturbing nerve or sphincter function, to eliminate the cancer.
MRI noted minimal infiltration in the perirectal fat plane and lymphadenopathy within the mesorectum
, with the largest lymph node having a short axis measuring 5 mm.
Restaging MRI revealed reduction in tumour size with areas within the mesorectum
consistent with perforation/infection that lies close to anterior circumferential resection margin.
While the lateral and posterior dissection of the mesorectum
can be easily done laparoscopically or robotically, we believe the anterior dissection of the rectum--removal of the endometriosis off the posterior aspect of the vagina while leaving it attached to the rectum--is more easily performed using a hand-assisted laparoscopic approach or even a hybrid open approach through the mini-Pfannenstiel incision.