Impact of Body Mass Index on Surgical and Oncological Outcomes in Laparoscopic Total Mesorectal Excision for Locally Advanced Rectal Cancer after Neoadjuvant 5-Fluorouracil-Based Chemoradiotherapy

Figure 1

Pictures from laparoscopic surgery in obese patients with locally advanced rectal cancer. (a) A medial to lateral dissection was performed, the IMA was skeletonized and ligated, the inferior mesenteric plexus was identified and protected; (b) the anterior space of rectum was well exposed, and the anterior layer of Denonvilliers’ fascia was dissected below the seminal vesicle; (c) the left “holy plane” was well exposed, the left NVB and pelvic autonomic nerve were identified and protected; (d) the right “holy plane” was well exposed, the right NVB and pelvic autonomic nerve were identified and protected; (e) the specimen with an intact mesorectum fascia; (f) the tumor was downsized after nCRT (tumor size: pre-CRT 2.5 cm, post-CRT 1.5 cm) with a distal resection margin of more than 2 cm; IMA: inferior mesenteric artery; NVB: neurovascular bundle.

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