Optimal complete rectum mobilization focused on the anatomy of the pelvic fascia and autonomic nerves: 30 years of experience at severance hospital

Nam Kyu Kim, Ho Seung Kim, Mohmmed Alessa, Radwan Torky

Research output: Contribution to journalReview articlepeer-review

Abstract

The primary goal of surgery for rectal cancer is to achieve an oncologically safe resection, i.e., a radical resection with a sufficient safe margin. Total mesorectal excision has been introduced for radical surgery of rectal cancer and has yielded greatly improved oncologic outcomes in terms of local recurrence and cancer-specific survival. Along with oncologic outcomes, functional out-comes, such as voiding and sexual function, have also been emphasized in patients undergoing rectal cancer surgery to improve quality of life. Intraoperative nerve damage or combined excision is the primary reason for sexual and urinary dysfunction. In the past, these forms of damage could be attributed to the lack of anatomical knowledge and poor visualization of the pelvic auto-nomic nerve. With the adoption of minimally invasive surgery, visualization of nerve structure and meticulous dissection for the mesorectum are now possible. As the leading hospital employing this technique, we have adopted minimally invasive platforms (laparoscopy, robot-assisted surgery) in the field of rectal cancer surgery and standardized this technique globally. Here, we review a standardized technique for rectal cancer surgery based on our experience at Severance Hospital, suggest some practical technical tips, and discuss a couple of debatable issues in this field.

Original languageEnglish
Pages (from-to)187-199
Number of pages13
JournalYonsei medical journal
Volume62
Issue number3
DOIs
Publication statusPublished - 2021 Mar

Bibliographical note

Publisher Copyright:
© Yonsei University College of Medicine 2021.

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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