Operation standard and application status of radical rectal cancer resection with preservation of Denonvilliers'fascia(iTME)navigated with Wei's Line
Since the concept of total mesorectal excision(TME)was proposed and carried out in 1982,the postoperative local recurrence rate of rectal cancer has decreased significantly and the long-term survival rate has increased,thus TME has become the gold standard for middle and low rectal cancer surgery.However,the incidence of postoperative urination and sexual dysfunctions caused by pelvic autonomic nerve injury during TME operation remains high,which needs to be investigated and solved.Over the years,through systematic studies of anatomy,histology and physiology,we have confirmed that dissection anterior to Denonvilliers'fascia for the anterior wall of rectum,and thus partial resection of Denonvilliers'fascia,were the leading cause of nerve injury during TME operation.On the contrary,dissection posterior to Denonvilliers'fascia and entire preservation of Denonvilliers'fascia are feasible and necessary.Moreover,through anatomical study,Wei's Line,the surgical marker line of Denonvilliers'fascia is discovered for the first time,and thus innovative TME(iTME)navigated with Wei's Line is proposed.The multi-center clinical study has confirmed that compared with traditional TME surgery,the incidences of postoperative urination and sexual dysfunctions in iTME group decrease significantly,with comparable oncologic outcomes,suggesting that iTME surgery could be a better choice for male patients with middle and low rectal cancer at specific stages.This study systematically reviews the research process and operation standard of iTME,and summarizes the application status and future prospects of iTME.
Wei'LineDenonvilliers'fasciainnovative total mesorectal excisionrectal neoplasmurogenital function
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