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We read with interest the recent article by Khatri et al.¹ The authors emphasize the need to conceptualize the dissection on the basis of a thorough understanding of the regional anatomy that confers improved safety. We fully agree that meticulous surgical technique is mandatory to radically remove the cancer while preserving important anatomic structures such as the membranous urethra, prostate, and presacral veins, but we are disappointed that Khatri et al¹ omitted the details of pelvic neuroanatomy and did not discuss autonomic nerve preservation, which is important to proper urinary and sexual function, during abdominoperineal resection of the rectum.²

Recent research results^2-3 support the feasibility of preserving pelvic neural structures but also stress their variable location, which can create difficulties in ensuring nerve preservation. In men, the inferior hypogastric plexus is located between the urinary bladder and rectum in 73% and pararectally in 27%.³ In women, 57% of the plexuses . . . [Full Text of this Article]

Julian E. Losanoff, MD; Edward R. Sauter, MD, PhD
Columbia, Mo

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Pelvic Neuroanatomy and Technique of Abdominoperineal Resection of the Rectum for Cancer—Reply
Vijay P. Khatri, Miguel Rodriguez-Bigas, and Nicholas J. Petrelli
Arch Surg. 2004;139(2):225.
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