Nerve-sparing surgery in rectal cancer: Feasibility and functional results

Traditional rectal cancer surgery has been burdened with a high rate of sex ual and urinary dysfunctions due to intraoperative injury or the cutting of the sympathetic and/or parasympathetic nerves. The experience acquired in the last ten years with total mesorectal excisio ns has permitted the use of the "nerve-sparing" technique. The present stud y regards 239 patients from two surgical centres, most of whom underwent sp hincter-saving radical surgery between 1994 and 1998 with the above mention ed technique for resectable colon cancer. Details regarding the technique w ere recorded in the last 58 patients, in order to examine the severity of t he surgical damage. The subgroup with the longest follow-up, which included 36 patients, was diagnostically evaluated by a surgeon, psychologist, urol ogist and neurologist to analyze the risk of sexual and urinary dysfunction s. A complete nerve-sparing was perfomed in 86.3% of the cases. The parasympathetic nerve trunks were those most often damaged because of p erineural tumor spreading. Partial to complete sexual impotence was observe d in 44% of the patients and surprisingly, preoperative dysfunctions were d etected by means of the multidisciplinary approach in one third of these pa tients. Therefore, only 30.5% of the patients presented with strictly postoperative sexual impotency, above all, those who had undergone high-dose preoperativ e chemoradiation for T-3 or T-4 middle to low rectal cancer. A prospective study was initiated to evaluate the genitourinary dysfunctions after rectal cancer surgery in all of the clinical phases by means of a multidisciplina ry approach aimed at functional recovery and improved quality of life.