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Objective: To identify the location and contents of the rectal lateral ligaments and its relationship with the middle rectal artery and pelvic plexus., Methods: Twenty-nine pelvics of human cadavers were sagittally sectioned into 58 hemipelvic specimens. All of hemipelvics were dissected with sharp technique under direct vision by one surgeon. The lateral ligaments were identified and the distances from the center of its pelvic attachment to sacral promontory and coccyx were measured. Then, the lateral ligaments were transected for histologic examination., Results: Lateral ligaments of rectum were found in all 58 hemipelvics. The lateral ligaments connected the posterolateral aspect of the middle 1/3 of the rectum and mesorectum to the lateral aspect of the bodies of the second, third and fourth sacral vertebrae. The distance from the lateral ligament to sacral promontory was (8.3 +/- 1.6) cm on the right side and (8.4 +/- 1.4) cm on left side. The width of lateral ligaments was (3.2 +/- 0.4) cm on the right side and (3.1 +/- 0.4) cm on the left side. The distances from lateral ligament to the coccyx on the right and left sides were (5.2 +/- 1.4) cm and (5.0 +/- 1.3) cm respectively. The content of the lateral ligaments consisted of loose connective tissue with clusters of small nerves and blood vessels. Middle rectal artery was found in 83% (48/58) of hemipelvics and 47% (27/58) of the middle rectal artery went through the lateral ligaments. The inferior hypogastric nerve plexuses were formed inside the lateral ligament, and separated the ligament into two parts. The lateral segment of the lateral ligament contained the tributaries of internal iliac artery, and the medial segment contained nerve fibers or branches to the rectum, together with the middle rectal artery., Conclusion: The lateral ligaments of rectum are located on the posterolateral side of the rectum, much closer to the coccyx than to the sacral promontory, consisting of connective tissue containing multiple small nerves and middle rectal artery. The lateral ligament is a pathway of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.

Objective: To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in prediction of pathological staging and involvement of circumferential resection margin (CRM) in rectal cancer., Methods: Fifty-three patients undergoing total mesorectal excision for biopsy-proven rectal cancer were assessed prospectively using high-resolution MRI for tumour (T) and mesorectal nodal (N) staging as well as CRM status using the depth of tumour spread, tumour node metastasis and CRM involvement. Preoperative MRI assessment of these prognostic factors was compared with the histopathological findings in carefully matched whole-mount sections of the specimen., Results: MRI correctly staged the tumor in 41 patients, understaged in 8, and overstaged in 4. The accuracy of T stage was 77.4% (41/53). There was ageneric correlation between pathologic and MRI tumor staging (Kappa = 0.602, P < 0.001). Node status was correctly staged in 37 patients, overstaged in 10, and understaged in 6. The accuracy of node staging was 69.8% (37/53), sensitivity was 75% (18/24), and specificity was 65.5% (19/29). The correlation between pathologic and MRI node staging was poor (Kappa = 0.399, P = 0.003). The CRM status was correctly reported in 51 patients, overstaged in 1, and understaged in 1. The accuracy of CRM status was 96.2% (51/53), sensitivity was 80% (1/5), and specificity was 97.9% (47/48). There was a good correlation between pathologic and MRI CRM involvement (Kappa = 0.779, P < 0.001)., Conclusion: Preoperative MRI provides poor predictive data as to subsequent pathologic tumor and mesorectal node stage, but does produce reliable prediction of clear CRM.

Objective: Evaluation of single stapler combined with prolapsing technique for anus-preserving of ultra-low rectal cancer and its indication as well as surgical procedure., Methods: Forty-three patients with ultra-low low rectal cancer suitable for anterior resection were divided into two groups, single stapler combined with prolapsing technique was applied for experiment group, conventional double stapler technique was applied for control group. To compare the distal margin, local recurrence rate, complications, anal continence function and expenses., Results: The distal margin of experimental group is significantly longer than that of control group (2.2 cm +/- 0.2 cm VS 1.9 cm +/- 0.4 cm, P = 0.006). The distance between dentate line and distal incision line of control group is much longer than experimental group (1.9 cm +/- 0.5 cm VS 1.3 cm +/- 0.3 cm, P < 0.001). There is no recurrence in experimental group but 3 cases recurrence within 1 year in control group. The anastomose fistula rate, instrument expenses of experimental group are less than those of control group. There is no distinct in anal continence between two groups. Occasional minor soiling is present in 1 case of experimental group., Conclusion: Single stapler combined with prolapsing technique is superior to double stapler technique for anus-preserving of ultra-low rectal cancer.