Partial preservation of Denonvilliers fascia during total mesorectal excision: a balance between oncologic outcomes and functional results

Dissection of the pre-rectal space is a challenging point in total mesorectal excision (TME). The reason is that it is difficult to ensure the integrity of the anterior proper fascia while preserving Denonvilliers fascia. In conversely, it is also difficult to resect Denonvilliers fascia without damaging the neurovascular bundles. It is the difficulty and focus of rectal cancer surgery to solve this contradiction. In recent years, TME based on the fascial anatomy provides a new perspective for researchers to design the best surgical approach for accurate peri-rectal dissection. In this paper, the authors focus on the fascia anatomical research progress of Denonvilliers fascia, and discuss the surgical approaches and techniques of partial preservation of Denonvilliers fascia during TME based on their own clinical experiences.