Where does pelvic nerve injury occur during rectal surgery for cancer?

Abstract

In most cases, the pelvic nerves can be preserved during rectal surgery. Complete oncological resection may require dissection close to the nerves where the tumour is located anterolaterally where it is fixed and when the pelvis is narrow.

New Insights into Autonomic Nerve Preservation in High Ligation of the Inferior Mesenteric Artery in Laparoscopic Surgery for Colorectal Cancer

“…Though the root of inferior mesenteric artery (IMA) is widely accepted as one of the crucial areas at risk of damage to the autonomic nerves (Moszkowicz et al, 2011;Acar et al, 2012), reliable surgical techniques of the autonomic nerves preservation in high ligation of the IMA has been vague for lacking of definite anatomical evidences. It is demonstrated in the present study that the relationships between the root of the IMA and its bilateral autonomic nerve plexuses are different and guided by the anatomical evidence, the bilateral autonomic nerves can be preserved clearly in high ligation of the IMA in laparoscopic surgeries for colorectal cancer.…”

“…However, it is widely accepted that high ligation of the IMA takes a risk of damage to the autonomic nerve plexuses around it (Moszkowicz et al, 2011;Acar and Kuzu, 2012) which may cause postoperative urogenital dysfunction . One common view on preservation of the autonomic nerve plexuses in high ligation of the IMA is preserving the pre-aortic connective tissue intact and dissecting the root of the IMA a certain distance away from its origin.…”

Surgical and pathomorphological results of total mesorectumectomy by using waterjet dissection technique in patients with rectal cancer

“…Особенно высок риск травматизации тазовых нервов при работе в «критических точках», в том чи-сле у латеральной стенки прямой кишки и на уровне промонториума [20]. В связи с этим существуют даже предложения об отказе от применения в этих зонах каких-либо генераторов и возврате к использованию «острой» диссекции ножницами.…”

Urinary Dysfunction After Surgical Treatment for Rectal Cancer

“…ated with neural injury during surgery, which might occur even when TME is properly performed (27,30) . Lesions of the pelvic autonomic nerve plexus might occur either alone or in association with other lesions and are due to tumour infiltration, difficult dissection of large tumours, or inadequate dissection of the anatomic planes (27) .…”

“…The concept of total mesorectal excision (TME), which includes anatomical dissection of the pelvic fascia and recognition of vascular and nerve structures, has allowed better outcomes in terms of local recurrence and functional morbidity of the pelvic organs (11,12,15) . The function of the pelvic organs depends on the neural integrity of the pelvic autonomic plexuses; thus, its preservation is one of the priorities in surgery (6,27) . The voluntary control of the lower urinary tract depends on the adequate interaction of the autonomic innervation, mediated by sympathetic and parasympathetic fibres, with the somatic innervation, mediated by the pudendal nerves (7,19) .…”