Female near-TME: standardization of proctectomy in women with ulcerative colitis.

Traditionally, 2 surgical techniques for proctectomy in ulcerative colitis have been used: total mesorectal excision (TME), and close rectal dissection (CRD). Recently, our research group has proposed the standardization of the Near-TME technique, which unites the advantages of both methods. It decreases the risk of pelvic autonomic nerve injury and reduces the volume of mesorectal remnant. When performing the Near-TME, the anatomical landmarks differ between men and women, especially in the anterolateral hemicircumference. The objective of this paper is to standardize the Near-TME technique in women (Female Near-TME) using characteristic surgical-anatomic landmarks of the female pelvis based on illustrations and a real case treated laparoscopically. This technique should be carried out by surgeons with experience in inflammatory bowel disease surgery and extensive knowledge of surgical anatomy.

Cáncer de recto a nivel de la reflexión peritoneal. Exactitud de la RM preoperatoria y correlación anatomopatológica. Estudio prospectivo / Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study

Introducción Establecer la exactitud de la resonancia magnética (RM) para determinar la localización de los tumores rectales en relación con la reflexión peritoneal (RP) y su potencial afectación. Métodos Estudio prospectivo de 161 pacientes intervenidos por cáncer de recto. Las piezas quirúrgicas han sido analizadas mediante un método de doble tinción, superficie serosa con colorante naranja y grasa mesorrectal con tinta china, para comparar los resultados con la RM preoperatoria. Resultados Veintidós tumores se localizaron por encima, 65 a nivel y 74 por debajo de la RP. La RM clasificó la localización del tumor respecto a la RP de manera correcta en el 90,6% y fue capaz de detectar el 80,5% de los casos con infiltración de la RP. La RM presentó una exactitud del 92,5% para clasificar el tumor como intra o extraperitoneal. El 28,7% de los tumores por encima y a nivel de la RP presentaba anatomopatológicamente infiltración de la serosa peritoneal. Conclusiones La RM es una prueba precisa para determinar la localización de los tumores de recto en relación con la RP y su posible afectación. En el tallado macroscópico, el método de doble colorante es eficaz para determinar la afectación serosa (pT4a) y diferenciarla de la fascia mesorrectal (AU)

Introduction To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement Methods Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy. Results Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR. Conclusions Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface (AU)