RADICAL AND NERVE-PRESERVING SURGERY FOR RECTAL-CANCER IN THE NETHERLANDS - A PROSPECTIVE-STUDY ON MORBIDITY AND FUNCTIONAL OUTCOME

Background Operative procedures for primary rectal cancer from Japan c ombine pelvic nerve-preserving techniques with radical tumour resectio n to ensure optimal local tumour control with minimal bladder and sexu al dysfunction, A prospective study was undertaken to evaluate morbidi ty and functional outcome of such a technique in Dutch patients. Metho ds Forty-seven patients were operated on by a Japanese surgeon. Postop erative course was monitored, Voiding and sexual function were analyse d using questionnaires completed by patients. Results After operation, only prolonged paralytic ileus (five of 47 patients) and perineal wou nd dehiscence (five of 18) occurred more frequently than reported in l iterature. There were no deaths. No patient developed urinary incontin ence. Three of 11 women and 19 of 30 men were sexually active. Two men were impotent after operation, Impotence was related to sacrifice of the inferior hypogastric plexus (P = 0.037). Preservation of the super ior hypogastric plexus was crucial for ejaculation (P = 0.003). Conclu sion A relationship between sacrifice of specific nerve structures and accompanying dysfunction was established, The nerve-preserving techni que 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.