Surgical anatomy of the pelvis for total pelvic exenteration with distal sacrectomy: a cadaveric study
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ORIGINAL ARTICLE
Surgical anatomy of the pelvis for total pelvic exenteration with distal sacrectomy: a cadaveric study Masayuki Ishii1,2 · Atsushi Shimizu3 · Alan Kawarai Lefor3 · Yasuko Noda1 Received: 28 June 2020 / Accepted: 4 August 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Intraoperative bleeding from the pelvic venous structures is one of the most serious complications of total pelvic exenteration with distal sacrectomy. The purpose of this study was to investigate the topographic anatomy of these veins and the potential source of the bleeding in cadaver dissections. Methods We dissected seven cadavers, focusing on the veins in the surgical resection line for total pelvic exenteration with distal sacrectomy. Results The presacral venous plexus and the dorsal vein complex are thin-walled, plexiform, and situated on the line of resection. The internal iliac vein receives blood from the pelvic viscera and the perineal and the gluteal regions and then crosses the line of resection as a high-flow venous system. It has abundant communications with the presacral venous plexus and the dorsal vein complex. Conclusion The anatomical features of the presacral venous plexus, the dorsal vein complex, and the internal iliac vein make them highly potential sources of bleeding. Surgical management strategies must consider the anatomy and hemodynamics of these veins carefully to perform this procedure safely. Keywords Pelvic exenteration · Sacrum · Iliac vein · Hemodynamics · Cadaver
Introduction Total pelvic exenteration offers the best chance of cure for patients with locally advanced or recurrent rectal cancer invading the adjacent organs. When the tumor invades the sacrum, sacrectomy should be considered. The 5-year overall survival rate of patients treated with conventional radiotherapy alone was reported as less than 10% [1]. However, Milne et al. reported that the 5-year survival rate of patients Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02144-x) contains supplementary material, which is available to authorized users. * Masayuki Ishii [email protected] 1
Department of Anatomy, Bio‑imaging and Neuro‑cell Science, Jichi Medical University, Tochigi, Japan
2
Colorectal and Pelvic Surgery Division, Shinko Hospital, Wakinohamacho 1‑4‑47, Chuo‑ku, Kobe, Japan
3
Department of Surgery, Jichi Medical University, Tochigi, Japan
who underwent total pelvic exenteration with sacrectomy was as high as 38% [2]. Total pelvic exenteration with distal sacrectomy, in which the sacrum is resected below the second sacral vertebra, is regarded as the procedure of choice for maximal curability and minimal motor disturbances caused by resection of the sacral nerve. However, this radical resection is a challenge for surgeons because of its complex nature and high postoperative morbidity [3, 4]. Intraoperative bleeding is one of the most serious and lifethreatening complications of total pelvic exenteration with distal sacrec
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