Lateral pelvic lymphadenectomy and total nerve sparing for locally advanced rectal cancer in western patients

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.