Article Text

How to reduce anterior resection syndrome and post-operative complication after rectosigmoid resection
  1. Giulio Ricotta1,
  2. Elodie Gauroy1,
  3. Anne-Sophie Navarro1,
  4. Alejandra Martinez1,2 and
  5. Gwenael Ferron1,3
  1. 1Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, Languedoc-Roussillon Midi, France
  2. 2Department of Surgical Oncology and INSERM CRCT Team 1, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
  3. 3Department of Surgical Oncology and INSERM CRCT Team 19, Oncogenesis of Sarcomas, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
    1. Correspondence to Dr Giulio Ricotta, Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, Languedoc-Roussillon Midi, France; drgricotta{at}

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    Intestinal surgery is often required in the management of patients with gynecological malignancies, and the rectosigmoid colon is the bowel segment most frequently involved.1 2

    In rectal cancer, the total mesorectal excision technique represents the standard procedure for surgical excision. However, since its introduction, the risk of anastomotic leakage and pelvic infection has increased. Moreover, total mesorectal excision 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.3

    In gynecological malignancy, in cases where there is no deep macroscopic mesorectal disease, total mesorectal excision is not essential. Close rectal dissection technique is based on mesorectal sparing, and allows the preservation of the superior rectal artery while minimizing autonomic nerve damage.

    In a review evaluating these two different surgical procedures in rectal benign disease, close rectal dissection was associated with reduced nerve injury and pelvic sepsis, with a lower rate of anastomotic leakage and improved bowel function.4 These results were confirmed by Son et al in a retrospective study on patients with ovarian cancer, which showed no differences in oncologic outcomes.2

    In this video, we present an anterior pelvic exenteration associated with a rectosigmoid resection with the close rectal dissection technique in a woman aged in her 50s, who had been treated with definitive chemoradiotherapy and brachytherapy for locally advanced cervical cancer. Ten months after the end of treatment, the patient locally recurred, and an anterior pelvic exenteration (type I Magrina) with a rectosigmoid resection with close rectal dissection was performed.

    We describe the procedure of rectosigmoid resection with the close rectal dissection technique. To summarize, rectosigmoid resection is often necessary to achieve complete cytoreduction in gynecological malignancies. In cases of no macroscopic deep mesorectal localization of disease and without massive Douglas pouch involvement, total mesorectal excision is unnecessary. Close rectal dissection 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. Unfortunately, this surgical technique is not widely applied by surgeons, even when technically feasible. With this video, we aim to standardize its use (Video 1).

    Video 1 Close rectal dissection technique
    Figure 1

    Photo showing the close rectal dissection

    Data availability statement

    There are no data in this work.

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    Not applicable.


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    • Twitter @GiRicotta, @Alejandra

    • Contributors GR, EG, ASN: conceptualization, video editing, and writing-original draft. AM: conceptualization, project administration, supervision, and writing-review. GF: conceptualization, project administration, surgery and video recording, supervision, and writing-review. GR: guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.