Preliminary results of pelvic autonomic nerve-preserving surgery combined with intraoperative and postoperative radiation therapy for patients with low rectal cancer

Background: In Japan, lateral lymphadenectomy was widely performed for pati ents with stage It-lit rectal tumors because it was thought to contribute t o good local control, but the pelvic autonomic nerves were thus sacrificed. Although autonomic nerve-sparing surgery with lateral lymph node dissectio n has been tried from around 1987, the type of nerve sparing varied and the indications were not established, To examine the possibility of expanding the indications for total pelvic autonomic nerve preservation for patients with low rectal cancer, we conducted a pilot study. Methods: Between 1993 and 1997, a total of 50 patients with low rectal canc er underwent pelvic autonomic nerve preservation with lateral lymphadenecto my of both sides and intraoperative radiation therapy followed by postopera tive radiation therapy. Results: The median follow-up period for surviving patients was 41 months. The 3-year local control rates for ail patients, with stage I-II and stage ill tumors were 88% (95% confidence interval, 78-97%), 97% (90-100%) and 73 % (52-94%), respectively. The site of local recurrences was not near or wit hin the preserved plexus. Conclusions: The preliminary results showed good local control rate for pat ients with stage I-II tumors. For patients with stage III tumors, the local control rate was unsatisfactory, but nerve sparing was not the cause of lo cal recurrence. Further investigation of function-preserving surgery withou t decreasing curability is needed.