G. Di Matteo et al., Lateral pelvic lymphadenectomy and total nerve sparing for locally advanced rectal cancer in western patients, PANMIN MED, 43(2), 2001, pp. 95-101
Background. In an attempt to improve the results of locally advanced rectal
cancer treatment, we performed an extended surgical technique consisting o
f total mesorectal excision (TME), lateral pelvic lymphadenectomy (LPL) and
total nerve sparing (NS). Resection of the autonomic nerves was realized o
nly when these fibres were involved by the tumour.
Methods. Nine cases (9.2%) of a personal series of 98 western patients with
rectal carcinoma operated on between January 1992 and December 1997 at Thi
rd Department of Surgery, University "La Sapienza", Rome, underwent TME, LP
L and NS procedures for locally advanced extraperitoneal disease.
Results. Two out of seven patients in stage II/III suffered postoperatively
from urinary retention with mild irregular flow as tested on urodynamics,
but no long-term urinary disturbances persisted. Retrograde ejaculation occ
urred postoperatively in one of two patients who experienced urinary distur
bances. Another patient bad erection dysfunctions. These sexual dysfunction
s did not improve during the long-term followup. Seven patients with stage
II or stage III disease achieved a 5-year survival rate of 80.0% and a 5-ye
ar disease-free survival rate of 68.6% after a mean follow-up period of 64.
7 months. None of them experienced local recurrence, but one patient died o
f diffuse metastatic disease 50 months after surgery. Two patients with sta
ge IV rectal carcinoma died of local and distant disease 13 months and 35 m
onths after operation. One patient underwent liver resection for solitary m
etastasis 25 months after primary operation.
Conclusions. TME, LPL, and NS with resection of autonomic nerves only when
these fibres are involved by the disease can achieve satisfactory results i
n terms of survival and functional outcome in selected western patients wit
h locally advanced rectal cancer.