Radical and nerve-preserving surgery for rectal cancer in the Netherlands: a prospective study on morbidity and functional outcome

Abstract

A relationship between sacrifice of specific nerve structures and accompanying dysfunction was established. The nerve-preserving technique yields good results in terms of morbidity and functional outcome, and should be considered for adoption as a standard surgical procedure for primary rectal cancer.

Impact of Total Mesorectal Excision on Bladder and Sexual Function in Rectal Cancer

“…Using IPSS, resultant bladder dysfunction was 90% and 3 months post-surgery 33 patients were having same IPSS as before surgery, so at 3 months after surgery resultant bladder dysfunction was 28%. This is consistent with results with other studies i.e., Kim et al [12], Maas et al [22] and Ameda et al [23], as the voiding dysfunction in their studies were 26%, 28% and 30% respectively.…”

“…During rectal surgery, the ANP procedure causes less impairment of genitourinary function [22,28,31]. Similarly, our study showed no significant complications related to voiding.…”

“…Results of studies on male sexual function after rectal cancer surgery show impotence rates varying from 20% to 50% [16,24,33]. Ameda et al [23] reported that postoperative EF was a serious complication, even in complete nerve preservation [22]. Hendren et al [34] also reported that a high rate of sexual dysfunction is detected after rectal cancer excision, despite the use of nervepreserving techniques.…”

Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer

“…After unilateral resection the majority of patients can urinate spontaneously again only after 2 months. (59,99). Vesicourethral dysfunction occurs after LAR and APE in the early post-operative phase in 30 -70 % of patients if the autonomic nerves are not specifically preserved or cannot be correctly identified in an effort to preserve the nerves (1,76,77) Obstructive disorders after surgery attract more attention as they have to be treated acutely, although continence disorders are also common.…”

“…The connection between preservation of the nerves and preservation of bladder function could be demonstrated by intra-operative neuromonitoring (77).In patients with an positive test regarding an adequate increase in bladder pressure,the IPPS items weak stream,incomplete emptying and frequency of micturition varied significantly from those with negative test result. According to various studies, if the autonomic nerves are identified the VD rate can be expected to fall significantly to between 0 and 23 %, whereby generally rates of about 10 % and lower are given and some of the patients had a pre-existing VD (2,6, 35,46,70,75,77,99,114,133). Risk factors for VD are pre-existing disorders, tumor size over 5 cm (75), deep-seated tumor and APE (155,157), blood loss (84), age > 65 years (155).…”