Abstract
An understanding of the physiology and structure of rectum and anus, their related structures within the pelvis, and their embryological origins, is important when considering rectal cancer surgery in terms of precise dissection in anatomical planes, oncological clearance and functional impact for the patient. This includes sphincter preservation with restoration of gastrointestinal continuity, as well as preservation of urinary and sexual function. It is by a deeper understanding of pelvic anatomy and embryology that due to the proximity of pelvic structures damage and potential for functional compromise may be avoided when planning and carrying out rectal cancer treatment strategies. This chapter gives an overview of pelvic anatomy and physiology with specific reference to the operative technical considerations but also underpins the principles by which pre-operative staging assessment and adjuvant treatment are conducted in the overall management of rectal cancer.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Further Reading
Brown G, Kirkham A, Williams GT, et al. High resolution MRI of the anatomy important in total mesorectal excision of the rectum. Am J Roentgenol. 2004;182:431–9.
Burton S, Brown G, Daniels IR, et al. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer. 2006;94:351–7.
Chan CL, Scott SM, Williams NS, Lunniss PJ. Rectal hypersensitivity worsens stool frequency, urgency and lifestyle in patients with urge faecal incontinence. Dis Colon Rectum. 2005;48(1):134–40.
Garcia-Armengol J, Garcia-Botello S, Martinez-Soriano F, Roig JV, Lledo S. Review of the anatomic concepts in relation to the retrorectal space and endopelvic fascia: Waldeyer’s fascia and the rectosacral fascia. Colorectal Dis. 2008;10:298–302.
Gladman MA, Scott SM, Chan CL, Williams NS, Lunniss PJ. Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and faecal incontinence. Dis Colon Rectum. 2003;46(2):238–46.
Havenga K, DeRuiter MC, Enker WE, Welvaart K. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg. 1996;83:384–8.
Havenga K, Enker WE, Mcdermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with nerve preservation for carcinoma of the rectum. J Am Coll Surg. 1996;182:495–502.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.
Heald RJ, Moran BJ. Embryology and anatomy of the rectum. Semin Surg Oncol. 1998;15:66–71.
Kinungasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K. Operating behind Denonvilliers’ fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histological study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum. 2006;49:1024–32.
Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence and implications for the colorectal surgeon. Br J Surg. 2000;87:1288–99.
Lindsey I, Warren BF, Mortensen NJ. Denonvilliers’ fascia lies anterior to the fascia propria and rectal dissection plane in total mesorectal excision. Dis Colon Rectum. 2005;48:37–42.
Maslekar S, Sharma A, Macdonald A, Gunn J, Monson JR, Hartley JE. Mesorectal grades predict recurrence after curative resection for rectal cancer. Dis Colon Rectum. 2006;50:168–75.
Moran B, Heald RJ. Manual of total mesorectal excision. Boca Raton: CRC Press, Taylor & Francis Group; 2013.
Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;328:996–9.
Rao SSC, Hatfield R, Soffer E, et al. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 1999;94:773–83.
Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. Edinburgh: Churchill Livingstone; 2004.
Stelzner S, Holm T, Moran BJ, et al. Deep pelvic anatomy revisited for a description of crucial steps in extralevator abdominoperineal excision for rectal cancer. Dis Colon Rectum. 2011;54:947–57.
Uchimoto K, Murakami G, Kinugasa Y, Arakawa T, Matsubara A, Nakajima Y. Rectourethralis muscle and pitfalls of anterior perineal dissection in abdominoperineal resection and intersphincteric resection for rectal cancer. Acta Sci Int. 2007;82:8–15.
West NP, Finan PJ, Anderin C, et al. Evidence of the oncological superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol. 2008;26:3517–22.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag London
About this chapter
Cite this chapter
Chadwick, M. (2015). Anatomy and Physiology of the Rectum and Anus. In: Longo, W., Reddy, V., Audisio, R. (eds) Modern Management of Cancer of the Rectum. Springer, London. https://doi.org/10.1007/978-1-4471-6609-2_3
Download citation
DOI: https://doi.org/10.1007/978-1-4471-6609-2_3
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-6608-5
Online ISBN: 978-1-4471-6609-2
eBook Packages: MedicineMedicine (R0)