Chinese consensus on Denonvilliers' fascia preserving total mesorectal excision (iTME) (2021 version).
10.3760/cma.j.cn.441530-20210407-00147
- Collective Name:Minimally Invasive Anatomy Group, Colorectal Cancer Committee of Chinese Medical Doctor Association;Colorectal and Anal Function Surgeons Committee of China Sexology Association
- Publication Type:Journal Article
- Keywords:
Chinese consensus;
Denonvilliers' fascia preserving total mesorectal excision (iTME);
Ejaculation dysfunction;
Erectile dysfunction;
Rectal neoplasms;
Urinary dysfunction
- MeSH:
China;
Consensus;
Fascia;
Humans;
Neoplasm Recurrence, Local;
Quality of Life;
Rectal Neoplasms/surgery*;
Rectum/surgery*
- From:
Chinese Journal of Gastrointestinal Surgery
2021;24(6):467-472
- CountryChina
- Language:Chinese
-
Abstract:
In 1982, total mesorectal excision(TME) was proposed by Professor R. J. Heald, which was a milestone-style for rectal cancer surgery. The concept of TME has reduced the local recurrence rate of mid-low rectal cancer (MLRC) significantly, thus becomes the gold standard for MLRC surgery. However, the incidence of urogenital dysfunction after TME remains high, among which urinary dysfunction reaches 30%-60%, and sexual dysfunction reaches 50%-70%. In recent years, studies have shown that the removal of Denonvilliers' fascia (DVF) during TME is an important cause of postoperative urination and sexual dysfunction. Therefore, DVF preserving total mesorectal excision (iTME) has been recognized by more and more surgical experts. On the basis of existing literature and clinical practice, we organize experts to discuss and vote, put forward recommendations for several issues of iTME, and finally formulate this expert consensus. The formulation of this consensus aims to increase surgeons' awareness of the value and functional protection of DVF during TME surgery, clarify the indications and contraindications of iTME, and standardize the procedure of iTME, so as to reduce postoperative urination and sexual dysfunction and improve the quality of life of patients with MLRC. The level of evidence and recommendation of this consensus is determined by Grading Recommendations, Assessment, Development and Evaluation (GRADE), and the consensus content is determined through expert voting and Delphi method.
