Current research status on pelvic autonomic nerve monitoring in rectal cancer surgery / 中华胃肠外科杂志

Rectal cancer is a common malignant tumor of the digestive tract, and surgery is the main treatment strategy. Disorders of bowel, anorectal and urogenital function remain common problems after total mesorectal resection (TME), which seriously decreases the quality of life of patients. Surgical nerve damage is one of the main causes of the complications, while TME with pelvic autonomic nerve preservation is an effective way to reduce the occurrence of adverse outcomes. Intraoperative nerve monitoring (IONM) is a promising method to assist the surgeon to identify and protect the pelvic autonomic nerves. Nevertheless, the monitoring methods and technical standards vary, and the clinical use of IONM is still limited. This review aims to summarize the researches on IONM in rectal and pelvic surgery. The electrical nerve stimulation technique and different methods of IONM in rectal cancer surgery are introduced. Also, the authors discuss the limitations of current researches, including methodological disunity and lack of equipment, then prospect the future direction in this field.

Perirectal fascial anatomy and pelvic autonomic nerve preservation during the transanal total mesorectal excision / 中华胃肠外科杂志

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.

Effect of pelvic autonomic nerve preservation for urinary function and sexual dysfunction after resection of rectal cancer in male patients / 中国综合临床

Objective To investigate the effect of pelvic autonomic nerve preservation (PANP) for urinary function and sexual dysfunction after total mesorectal excision (TME) of rectal cancer in male patients. Methods A total of 147 patients, hospitalized from March 2009 to March 2010,were enrolled into this study and received TME plus PANP combination treatment. The clinical data of these cases were analyzed retrospectively. Results There were no operative deaths. The 0. 5 - 1.0 years follow-up data showed that 9 cases (6. 12% ) had voiding dysfunction, 11 cases (7.48%) had sexual dysfunction, 12 cases ( 8.16% ) had local recurrence. Conclusion TME plus PANP combination treatment can improve the urinary and sexual function,without increasing the postoperative local recurrence rate.

Influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer / 中华消化外科杂志

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.

Assessment of Sexual and Voiding Function after Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation in Male Rectal Cancer Patients

PURPOSE: The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function. METHODS: We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients. RESULTS: There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9+/-5.7 vs 13.7+/-7.0, 240+/-91.9 vs 143+/-78, P0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2+/-5.8 to 9.8+/-5.9 (P<0.05). There were no changes of score for one of each seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2+/-9.3 vs 13.5+/-9.0, 8.4+/-4.2 vs. 4.4+/-2.9, 5.8+/-2.9, vs. 4.4+/-2.9, 6.1+/-2.4 vs. 4.8+/-2.0, 6.1+/-2.2 vs. 4.5+/-2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile function: P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors. CONCLUSIONS: TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.