A prospective study on radical and nerve-preserving surgery for rectal cancer in The Netherlands

Introduction: Preservation of the pelvic autonomic nerves is thought to low er bladder and sexual dysfunction after rectal cancer surgery. A prospectiv e study was undertaken in a Dutch population to evaluate functional outcome , local recurrence and survival of a Japanese operative technique combining nerve preservation with radical tumour resection. Methods: Forty-seven patients were operated upon by a Japanese surgeon. Voi ding and sexual function were prospectively analysed using questionnaires. Two-year follow-up on urinary function was complete in 73%, and 2-year foll ow-up of male sexual function was complete in 77%. Median follow-up for sur vival and recurrence was 42 months and was complete in all patients. Results: Five patients (19%) developed minor urinary incontinence in the pe riod between 1 and 2 years of followup. Six patients (22%) had a persistent ly elevated frequency of voiding. There was no statistically significant co rrelation between the extent of nerve preservation and the reported minor v oiding dysfunctions. None of the patients reported major incontinence of ur ine. Impotence was related to sacrifice of the inferior hypogastric plexus and ejaculatory dysfunction was related to sacrifice of the superior hypoga stric plexus. Sexual function did not change during followup. Of 42 curativ ely-operated patients, three (7.1%) developed local recurrence. Sixty-seven per cent were overall free of recurrence. Disease-free survival was 57%. Conclusions: Preservation of the pelvic autonomic nerves minimizes bladder dysfunction after rectal cancer surgery. The preservation of the total auto nomic nerve system is essential for normal sexual function in male patients . Nerve preservation does not compromise radicality in mesorectal excision. Mesorectal excision should involve identification and preservation of the pelvic autonomic nerves. (C) 2000 Harcourt Publishers Ltd.