Introduction/Background Intestinal surgery is often required in the management of patients with gynecological malignancies and the rectosigmoid colon is the most frequently bowel segment involved.

In rectal cancer, the total mesorectal excision (TME) technique represents the standard procedure. However, since its introduction, the risk of anastomotic leakage and pelvic infection increased.

Moreover, it is associated with pelvic and rectal autonomic nerve injury, which may cause ‘anterior resection syndrome’ defined as disordered bowel function after rectal resection, leading to a detriment in quality of life.

In gynecological malignancy, in case of no macroscopic mesorectal localization of disease, TME is unnecessary.

Close rectal dissection (CRD) technique is based on mesorectal sparing and allows the preservation of the superior rectal artery and minimizes autonomic nerve damage.

In a review evaluating these two different surgical procedures in rectal benign disease, CRD was associated with reduced nerve injury, pelvic sepsis, a lower rate of anastomotic leakage and improved bowel function.

These results were confirmed in a retrospective study on patients with ovarian cancer without differences in oncologic outcomes.

Methodology In this video, we present an anterior pelvic exenteration associated with a rectosigmoid resection with the CRD technique in a 56-year-old woman treated with definitive chemoradiotherapy and brachytherapy for locally advanced cervical cancer. Ten months after the end of the treatment, patient locally recurred and an anterior pelvic exenteration (Type I Magrina) with a rectosigmoid resection with CRD was performed.

Results We describe the procedure of rectosigmoid resection with the close rectal dissection technique.

No intra-operative or post-operative complication occurred.

Conclusion If a rectosigmoid resection is necessary, but there is no macroscopic mesorectal localization of disease, TME is unnecessary.

CRD allows better anastomotic vascularization by preserving the superior rectal artery and reducing nerve injury, with a lower rate of anastomotic leakage, pelvic sepsis, and improved bowel function.

Disclosures The authors declare that they have no conflict of interest.