The anatomical substrate for a difference in surgical approach to rectal cancer in male and female patients.

This review emphasizes' gender related anatomical differences warranting a difference in surgical approach to the problem of rectal cancer in men and women. Differences in the anatomy of the bony pelvis, the pelvic viscera and the lymphatics of the rectum, inspired the authors to extend the margins of the rectal resection in the anterior plane in female patients. Between 1978 and 1992 a rectal resection was carried out for cancers confined to the pelvis in 158 patients. Of these patients 152 were available for review, 95 male and 57 female. In 24 out of 57 female patients extension of the rectal resection towards the genital tract by en bloc excision of posterior vaginal wall and/or uterus was considered necessary to be confident about obtaining tumour free margins. After a median follow-up of 8 years the risk of local recurrence and cancer related death were significantly lower in female patients.