MESORECTUM TARGET DELINEATION

MESORECTUM TARGET DELINEATION

1. MANAGEMENT OF DIFFUSE GLIOMAS 5/11/2023 1 DR KANHU CHARAN PATRO MD,DNB (Radiation Oncology),MBA,FICRO,FAROI(USA ),PDCR,CEPC HOD(Radiation Oncology) Mahatma Gandhi Cancer Hospital And Research Institute, Visakhapatnam [email protected] M-9160470564 TARGET DELINEATION OF MESORECTUM

2. Mesorectum (M): The M is the fat around the rectum, bounded by the mesorectal fascia (MRF). In the mid-low pelvis, the M is anteriorly bound by the MRF and by the posterior border of the anterior pelvic organs (prostate, seminal vesicles, bladder and penis bulb in men and vagina and uterus in women).

3. What is Mesorectum ? Mesorectum : The mesentery of the rectum, i.e.,  mesorectum , is the perirectal fatty lymphovascular tissue extending the length of the rectum. The   mesorectum  encases the rectum as a thick cushion mainly posteriorly and laterally.

4. What is Mesorectum ? The  mesorectum  is the perirectal fat that surrounds the rectum. It is not an  anatomical  termed recognized by the Terminologia Anatomical because it is mainly a surgical and radiological term for rectal cancer staging . It encloses the rectum and is limited superficially by the mesorectal fascia.

5. Mesorectum content? Mesorectum  tissue “en bloc” removes lymphatic, vascular, perineal tumor deposits . Positive CRM  is  defined as a tumor extension (continuous or discontinuous) or the presence of positive lymph nodes <1 mm from the radial, non peritonealized soft tissue border.

6. 5/11/2023 6

7. 5.Mesorectum 5/11/2023 7

8. 5/11/2023 8 6 . MRF- mesorectal fascia

9. MESORECTUM BOUNDARY M: Mesorectum, LLN: Lateral Lymph Nodes EIN: External Iliac Nodes, IN: Inguinal Nodes, IRF: Ischio -Rectal Fossae , SC: Sphincter Complex, IMA: inferior mesenteric artery, SA: sigmoid artery, SRA: superior rectal arteryxx

10. Branches of IMA 5/11/2023 11

11. Inferior mesenteric artery branches The branches of the inferior mesenteric artery include Left colic , which is located retroperitoneally and supplies the  descending colon ; Sigmoid  branches, which supply the  sigmoid colon ; and Superior rectal artery , which is the terminal branch of the inferior mesenteric artery at the pelvic brim

12. CORONAL VIEW

13. Levator LEVATOR

14. IMA ORIGIN ORIGIN

15. Bifurcation SA and SRA BIFURCATION

16. MRF MRF

17. CORONAL LEVATOR

18. AXIAL ANTERIOR

19. SAGGITAL