The mean number of lymph nodes found in the mesorectum distal to the superior rectal artery division was 8.4. Most of these lymph nodes were proximal to the peritoneal reflection. The range found in the number of lymph nodes per case should be considered for use in the formulation of guidelines in anatomicopathologic studies of surgical specimens obtained after mesorectal excision.

The mean number of lymph nodes found in lateral pelvic wall compartments was 28.6 per specimen. The group containing most lymph nodes lies in the obturator fossa. Complete excision of hypogastric lymph nodes demands a deep pelvic dissection of neurovascular structures.

Santiago Cubas, 0000-0001-6026-5316; Martín Varela, 0000-0003-2376-2844; María N. Brito, 0000-0002-1394-3994; Andrés Pouy, 0000-0002-7136-144X; Nicolás D. Muniz, 0000-0002-6235-1303; Camila Haro, 0000-0003-4475-9740; Marysol Martínez, 0000-0001-8372-2006; César E. Canessa, 0000-0003-0446-7823.

A modification of the dorsal rectal approach is described as an alternative to consider in selected low and middle rectal lesions unsuitable for the transanal approach. The dorsal rectal approach is performed through the sacrococcygeal joint and below the gluteus maximus muscle resulting in an easier, safe, and well-tolerated procedure.