Mesorectal excision: Surgical anatomy of the rectum, mesorectum, and pelvic fascia and nerves and clinical relevance

Core Tip

Core tip: Radical resection of rectal cancer entails removal of the rectum with its fascia as an intact unit while preserving surrounding vital structures. The procedure is technically challenging because of the complex multilayered pelvic fascia and intimate relationship between the rectum and vital surrounding structures. Despite the clear-cut “text book” description of surgical technique and straightforward manner of handling different structures in the pelvis, there are many variations and contradictory accounts reported in the literature as to the nature, anatomy and significance of some of the structures, proper plane of dissection, and the optimal technique to achieve oncological resection while decreasing urogenital and bowel dysfunction.