INTRODUCTION: 

It has been considered difficult to achieve en bloc resection in cases of locally advanced rectal cancer with lateral pelvic sidewall invasion. The present study demonstrates a novel surgical procedure for these tumors.

TECHNIQUE: 

There are 3 avascular planes of the retroperitoneum in the pelvic sidewall. Two visceral pelvic fasciae, namely the ureterohypogastric fascia and umbilical prevesical fascia, and the parietal pelvic fascia can be identified. In addition, the key structures of these fasciae, the ureter, umbilical artery, and external iliac vessels, can be identified transperitoneally before any dissection. Thus, these 3 avascular planes can be dissected without resorting to dissection of the retrorectal space. The key steps to this technique are: 1) after dissection from the side opposite to the site of tumor invasion to the dorsal side of the rectum, the avascular planes of the retroperitoneum among the 3 above-mentioned fasciae are dissected; and 2) the retrorectal space and pelvic sidewall space are connected by sharp dissection.

RESULTS: 

Recognizing the 3 above-mentioned fasciae enables the dissection of the avascular planes of the pelvic sidewall, which helps to achieve en bloc dissection in cases of locally advanced rectal cancer with lateral pelvic sidewall invasion.

CONCLUSION: 

The pelvic sidewall could be divided into 3 areas based on the visceral pelvic fasciae, which has helped to achieve en bloc dissection in cases of locally advanced rectal cancer with lateral pelvic sidewall invasion.

中文翻译：

---

基于腹膜后血管的无血管平面扩大全直肠系膜切除术治疗局部晚期盆腔侧壁浸润的局部晚期直肠癌。

介绍： 

在局部晚期直肠癌合并盆腔侧壁浸润的病例中，整体切除被认为是困难的。本研究证明了一种针对这些肿瘤的新颖手术方法。

技术： 

骨盆侧壁有3个腹膜后无血管平面。可以识别出两个内脏骨盆筋膜，即输尿管胃胃筋膜筋膜和脐前膀胱筋膜，以及顶叶骨盆筋膜。另外，这些筋膜，输尿管，脐动脉和外血管的关键结构可在任何解剖前经腹膜识别。因此，可以解剖这3个无血管平面而无需借助直肠后腔的解剖。这项技术的关键步骤是：1）从肿瘤浸润部位的相反侧向直肠背侧解剖后，解剖上述3个筋膜中的腹膜后无血管平面；2）直肠后腔和骨盆侧壁腔通过尖锐的解剖相连。

结果： 

认识到上面提到的3条筋膜能够解剖盆腔侧壁的血管平面，这有助于在局部晚期直肠癌伴盆腔侧壁浸润的情况下实现整体解剖。

结论： 

根据内脏骨盆筋膜可将骨盆侧壁分为3个区域，这有助于在局部晚期直肠癌伴有骨盆侧壁外侧侵犯的情况下实现整体解剖。