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Pelvic autonomic nerve preservation for patients with rectal carcinoma: Oncologic and functional outcome
Author(s) -
Sugihara Kenichi,
Moriya Yoshihiro,
Akasu Takayuki,
Fujita Shin
Publication year - 1996
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19961101)78:9<1871::aid-cncr5>3.0.co;2-i
Subject(s) - medicine , sexual function , surgery , stage (stratigraphy) , lymph node , dissection (medical) , carcinoma , sexual dysfunction , autonomic nerve , urology , paleontology , biology
BACKGROUND Serious problems in the surgical treatment of patients with rectal carcinoma are local failure and urinary and sexual dysfunction. To resolve these problems, pelvic autonomic nerve preservation (PANP) combined with lateral lymph node dissection has been introduced. METHODS Of 238 consecutive patients with middle or low rectal carcinoma who underwent potentially curative surgery between 1987 and 1992, 214 underwent PANP according to pre‐ and intraoperative staging. PANP was evaluated from the perspectives of oncologic outcome and urinary and male sexual function with a retrospective questionnaire in a group of patients followed prospectively. RESULTS During the median follow‐up of 53 months, local recurrence developed in 5.6% of patients; no local recurrence was observed in Dukes Stage A or Dukes Stage B patients. The 5‐year survival rates of Dukes Stage A (n = 55), Dukes Stage B (n = 72), and Dukes Stage C (n = 87) patients were 96.4%, 84%, and 67.3%, respectively. Of patients undergoing preservation of the unilateral pelvic plexus alone, 93.5% maintained the ability to void spontaneously. Of patients who had complete preservation of the autonomic nerve system, 70.4% maintained male sexual function, and of patients who had removal of the hypogastric nerves and preservation of the pelvic nerve plexuses, 66.7% were capable of erection and intercourse without normal ejaculation. CONCLUSIONS Early stage rectal carcinoma should be treated both with local cure and complete preservation of urinary and sexual function. In high risk patients with suspected perirectal lymph node metastases and tumors invading the perirectal fat, the appropriate PANP should be applied with consideration of the balance between achieving a cure and preserving autonomic function. Cancer 1996;78:1871‐80.