PELVIC AUTONOMIC NERVE PRESERVATION FOR PATIENTS WITH RECTAL-CARCINOMA - ONCOLOGIC AND FUNCTIONAL OUTCOME

BACKGROUND. Serious problems in the surgical treatment of patients wit h rectal carcinoma are local failure and urinary and sexual dysfunctio n. To resolve these problems, pelvic autonomic nerve preservation (PAN P) combined with lateral lymph node dissection has been introduced. ME THODS. 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. T he 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 pe lvic plexus alone, 93.5% maintained the ability to void spontaneously. Of patients who had complete preservation of the autonomic nerve syst em, 70.4% maintained male sexual function, and of patients who had rem oval of the hypogastric nerves and preservation of the pelvic nerve pl exuses, 66.7% were capable of erection and intercourse without normal ejaculation. CONCLUSIONS. Early stage rectal carcinoma should be treat ed both with local cure and complete preservation of urinary and sexua l function. In high risk patients with suspected perirectal lymph node metastases and tumors invading the perirectal fat, the appropriate PA NP should be applied with consideration of the balance between achievi ng a cure and preserving autonomic function. [See Editorial on pages 1 847-50, this issue.] (C) 1996 American Cancer Society.