{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:01:39Z","timestamp":1780030899608,"version":"3.53.1"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The global incidence of rectal cancer is rising, accompanied by the increasing use of neoadjuvant chemoradiotherapy. Although this approach improves oncological outcomes, it frequently increases operative difficulty during rectal resection. Achieving a negative circumferential resection margin (CRM) remains critical to reducing local recurrence. While clear margins are often attainable utilising the standard total mesorectal excision (TME) plane, dissection beyond TME is increasingly required following neoadjuvant radiation or for locally advanced or recurrent disease. Such surgery demands detailed knowledge of complex pelvic anatomy and sound operative strategies to achieve optimal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This publication presents a novel \u2018onion peel\u2019 approach to pelvic anatomy comprising five sequential layers. Layer 1\u2014the TME plane; Layer 2\u2014the ureterohypogastric fascia and anterior viscera; Layer 3\u2014lymphovascular structures; Layer 4\u2014neural structures and Layer 5\u2014musculoskeletal anatomy. Within each layer, key anatomical features are outlined alongside practical operative strategies to facilitate safe dissection and recognition of vital structures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This paper provides colorectal surgeons with a novel overview of the anatomy surrounding the mesorectal envelope along with simple operative strategies to enter and safely dissect planes beyond TME.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70656","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T05:32:11Z","timestamp":1775626331000},"page":"1265-1269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Layer by Layer: The Anatomical \u2018Onion Peel\u2019 Approach to Surgery Beyond Total Mesorectal Excision"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5335-3270","authenticated-orcid":false,"given":"Sean","family":"Davis","sequence":"first","affiliation":[{"name":"Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine Adelaide University  Adelaide South Australia Australia"},{"name":"Colorectal Unit, Department of Surgery Royal Adelaide Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Barbaro","sequence":"additional","affiliation":[{"name":"Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine Adelaide University  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1398-3857","authenticated-orcid":false,"given":"Zachary","family":"Bunjo","sequence":"additional","affiliation":[{"name":"Discipline of Surgery, Faculty of Health and 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