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An anatomical study on intersphincteric space related to intersphincteric resection for ultra-low rectal cancer

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Abstract

Background

Intersphincteric resection (ISR) has been proposed to offer sphincter-sparing solution for patients with ultra-low rectal cancer. However, complete and accurate concepts about the intersphincteric space (ISS) related anatomy are not demonstrated clearly. This study aimed to provide a comprehensive description about the anatomic structure of ISS related to ISR.

Methods

This was a descriptive morphological study. 28 pelvic specimens were obtained from body donors. Macroscopic and microscopic observation of ISS was performed via gross anatomy, plastinated sections and histologic staining. The anatomical parameters of the anal canal were measured. Images of laparoscopic ISS dissection procedures were real-timely captured during ISR.

Results

The hiatal ligament, microvessels on supra fascia of LAM and rectal longitudinal muscle at the level of anorectal ring, especially at 1, 5, 7, and 11o’clock, could be the preferred entrance of ISS. The conjoint longitudinal muscle (CLM), the major component of ISS, was the continuum of the rectal longitudinal muscle and got reinforcement from the elastic fibers from LAM and EAS. Microvessels and neuro tissues were also found in ISS. The ISS was split into two spaces by the CLM in the middle and might subjectively be divided into three segments according to its different compositions. The length and width of ISS varied from different segments and directions.

Conclusions

We provided a systemic description of boundaries, contents and topographic structure of ISS, which may help proper determination of surgical approaches and dissection planes during ISR.

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Acknowledgements

The authors thank Department of Anatomy, Shanghai Medical College of Fudan University for provision of cadaver samples. The authors also thank Ms Qiwei Yu for support in the schematic diagram of the anal canal.

Funding

This work was supported by National Natural Science Foundation of China (No.82172705).

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Author notes

  1. Yiwen Zang and Minwei Zhou have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road (M), Shanghai, China

    Yiwen Zang, Minwei Zhou, Zhenyang Li, Xiaodong Gu, Yi Yang, Zihao Wang, Zongyou Chen, Yiming Zhou & Jianbin Xiang

  2. Department of Anatomy, Shanghai Medical College of Fudan University, Shanghai, China

    Deyan Tan

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  1. Yiwen Zang
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  2. Minwei Zhou
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Contributions

YZ and MZ are responsible for the design, analysis and drafting of this work, also the production of plastinated and microscopic sections. DT is responsible for the specimens and technique support. ZL, XG, YY and ZW are responsible for the gross anatomy and acquisition of data. ZC put forward the concept of this work. YZ and JX are responsible for interpretation of data and the final approval of this manuscript.

Corresponding authors

Correspondence to Yiming Zhou or Jianbin Xiang.

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Zang, Y., Zhou, M., Tan, D. et al. An anatomical study on intersphincteric space related to intersphincteric resection for ultra-low rectal cancer. Updates Surg 74, 439–449 (2022). https://doi.org/10.1007/s13304-022-01238-0

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  • DOI: https://doi.org/10.1007/s13304-022-01238-0

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