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Fang J, Wei B, Zheng Z, Xiao J, Han F, Huang M, Xu Q, Wang X, Hong C, Wang G, Ju Y, Su G, Deng H, Zhang J, Li J, Yang X, Chen T, Huang Y, Huang J, Liu J, Wei H. Preservation versus resection of Denonvilliers' fascia in total mesorectal excision for male rectal cancer: follow-up analysis of the randomized PUF-01 trial. Nat Commun 2023; 14:6667. [PMID: 37863878 PMCID: PMC10589235 DOI: 10.1038/s41467-023-42367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023] Open
Abstract
Traditional total mesorectal excision (TME) for rectal cancer requires partial resection of Denonvilliers' fascia (DVF), which leads to injury of pelvic autonomic nerve and postoperative urogenital dysfunction. It is still unclear whether entire preservation of DVF has better urogenital function and comparable oncological outcomes. We conducted a randomized clinical trial to investigate the superiority of DVF preservation over resection (NCT02435758). A total of 262 eligible male patients were randomized to Laparoscopic TME with DVF preservation (L-DVF-P group) or resection procedures (L-DVF-R group), 242 of which completed the study, including 122 cases of L-DVF-P and 120 cases of L-DVF-R. The initial analysis of the primary outcomes of urogenital function has previously been reported. Here, the updated analysis and secondary outcomes including 3-year survival (OS), 3-year disease-free survival (DFS), and recurrence rate between the two groups are reported for the modified intention-to-treat analysis, revealing no significant difference. In conclusion, L-DVF-P reveals better postoperative urogenital function and comparable oncological outcomes for male rectal cancer patients.
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Affiliation(s)
- Jiafeng Fang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Bo Wei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Zongheng Zheng
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Jian'an Xiao
- Department of Gastrointestinal Surgery, Anyang Cancer Hospital, the Fourth Affiliated Hospital, Henan University of Science and Technology, 1 Huanbin North Road, Anyang, People's Republic of China
| | - Fanghai Han
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, People's Republic of China
| | - Meijin Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, People's Republic of China
| | - Qingwen Xu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, People's Avenue, Zhanjiang, People's Republic of China
| | - Xiaozhong Wang
- Department of Gastrointestinal Surgery, Shantou Central Hospital, Waima Road, Shantou, People's Republic of China
| | - Chuyuan Hong
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Guangzhou Medical University, 250 Changgang East Road, Guangzhou, People's Republic of China
| | - Gongping Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Henan University of Science and Technology, 636 Guanlin Road, Luoyang, People's Republic of China
| | - Yongle Ju
- Department of Gastrointestinal Surgery, Shunde Hospital of Southern Medical University, 1 Licun Jiazi Road, Foshan, People's Republic of China
| | - Guoqiang Su
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Xiamen University, 55 Zhenhai Road, Xiamen, People's Republic of China
| | - Haijun Deng
- Department of General Surgery, Nanfang Hospital of Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou, People's Republic of China
| | - Jinxin Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, 74 Zhongshan Second Road, Guangzhou, People's Republic of China
| | - Jun Li
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Xiaofeng Yang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Tufeng Chen
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Yong Huang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Jianglong Huang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Jianpei Liu
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Hongbo Wei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, People's Republic of China.
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García-Gausí M, García-Armengol J, Pellino G, Mulas C, Roig JV, García-Granero A, Moro D, Valverde A. Navigating surgical anatomy of the Denonvilliers’ fascia and dissection planes of the anterior mesorectum with a cadaveric simulation model. Updates Surg 2022; 74:629-636. [PMID: 35286602 PMCID: PMC8995278 DOI: 10.1007/s13304-022-01252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
Abstract
Anterior dissection of the rectum in the male pelvis represents one of the most complex phases of total meso-rectal excision. However, the possible existence of different anatomical planes is controversial and the exact anatomical topography of Denonvilliers’ fascia is still debated. The aim of the study is to accurately define in a cadaveric simulation model the existence and boundaries of Denonvilliers’ fascia, identifying the anatomical planes suitable for surgical dissection. The pelvises of 31 formalin-preserved male cadavers were dissected. Careful and detailed dissection was carried out to visualize the anatomical structures and the potential dissection planes, simulating an anterior meso-rectum dissection. Denonvilliers’ fascia was identified in 100% of the pelvises, as a single-layer fascia that originates from the peritoneal reflection and descends until its firm adhesion to the prostate capsule. The fascia divides the space providing an anterior and a posterior plane. Anteriorly to the fascia, during the caudal dissection, its firm adhesion to the prostate capsule forces to section it sharply. The cadaveric simulation model allowed an accurate description of Denonvilliers’ fascia, defining several planes for anterior dissection of the meso-rectum.
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Affiliation(s)
- María García-Gausí
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
- Coloproctology Unit, European Center for Colorectal Surgery, Vithas Valencia 9 of October Hospital, Valencia, Spain
- Department of General and Digestive Surgery, Punta de Europa Hospital, Algeciras, Spain
| | - Juan García-Armengol
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
- Coloproctology Unit, European Center for Colorectal Surgery, Vithas Valencia 9 of October Hospital, Valencia, Spain
| | - Gianluca Pellino
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
- Coloproctology Unit, European Center for Colorectal Surgery, Vithas Valencia 9 of October Hospital, Valencia, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Claudia Mulas
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
- Coloproctology Unit, Department of General and Digestive Surgery, University General Hospital Consortium, Valencia, Spain
| | - José V. Roig
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
- Coloproctology Unit, European Center for Colorectal Surgery, Vithas Valencia 9 of October Hospital, Valencia, Spain
| | - Alvaro García-Granero
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
- Coloproctology Unit, Department of General and Digestive Surgery, Son Espases University Hospital, Palma, Spain
| | - David Moro
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
- Coloproctology Unit, Department of General and Digestive Surgery, Clinic University Hospital, Valencia, Spain
| | - Alfonso Valverde
- Surgical Anatomy Unit, Department of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Valencia, Avenida Blasco Ibañez, 15, 46010 Valencia, Spain
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