title: Where does pelvic nerve injury occur during rectal surgery for cancer?
abstract: OBJECTIVE
  Optimal treatment of rectal adenocarcinoma involves total mesorectal excision with nerve-preserving dissection. Urinary and sexual dysfunction is still frequent following these procedures. Improved knowledge of pelvic nerve anatomy may help reduce this and define the key anatomical zones at risk.
  
  
  METHODS
  The MEDLINE database was searched for available literature on pelvic nerve anatomy and damage after rectal surgery using the key words 'autonomic nerve', 'pelvic nerve', 'colorectal surgery', and 'genitourinary dysfunction'. All relevant French and English publications up to May 2010 were reviewed. Reviewed data were illustrated using 3D reconstruction of the foetal pelvis.
  
  
  RESULTS
  The ligation of the inferior mesenteric artery and dissection of the retrorectal space can cause damage to the superior hypogastric plexus and/or hypogastric nerve. Anterolateral dissection in the 'lateral ligament' area and division of Denonvilliers' fascia can damage the inferior hypogastric plexus and efferent pathways. Perineal dissection can indirectly damage the pudendal nerve.
  
  
  CONCLUSIONS
  In most cases, the pelvic nerves can be preserved during rectal surgery. Complete oncological resection may require dissection close to the nerves where the tumour is located anterolaterally where it is fixed and when the pelvis is narrow.
authors: Laboratory of Experimental Surgery, Faculty of Medicine, University Paris-Sud 11, Le Kremlin-Bicêtre, France.
authors: D
authors: D
authors: Moszkowicz
authors: B
authors: B
authors: Alsaid
authors: T
authors: T
authors: Bessede
authors: C
authors: C
authors: Penna
authors: B
authors: B
authors: Nordlinger
authors: G
authors: G
authors: Benoît
authors: F
authors: F
authors: Peschaud
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D006801:Humans; D007001:Hypogastric Plexus / Q000293:injuries*; D010388:Pelvis / Q000294:innervation*; D060525:Pudendal Nerve / Q000293:injuries*; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors