Long-term outcome of urinary function after extended lymphadenectomy in patients with distal rectal cancer

Aims: Extended lymphadenectomy for rectal cancer has been superseded by aut onomic nerve-sparing surgery, but it still has historical significance. It is useful to document the long-term outcome of urinary function in cases wh o had resection of the inferior hypogastric nerve plexus (pelvic nerve plex us). Methods: The long-term urinary function following extended lymphadenectomy was studied retrospectively through the medical records of 83 patients who had been followed-up for more than 5 years after surgery. Results: Forty-four per cent of the male patients and 17% of the female pat ients had to perform clean intermittent self-catheterization (CIC) for more than 1 year; these rates were almost the same at 3 years after the procedu re. Urinary incontinence was reported in 34% of the male patients and 45% o f the female patients. Complicated cystitis (eight patients), complicated p yelonephritis (two patients), bladder stones (five patients) that required surgical treatment, and chronic renal failure (two patients) were considere d as adverse outcomes of extended surgery. In particular, one case needed t o undergo urinary diversion. Conclusions: A surprisingly large proportion of patients suffered various u rinary tract problems due to extended lymphadenectomy. The findings demonst rate the importance of selection of well-balanced operations that can encom pass both radicality and quality of life. The extent of resection should be decided by the extent of the cancer and routine excision of the inferior h ypogastric nerve plexus should not be performed. (C) 2001 Harcourt Publishe rs Ltd.