Genito-urinary function after lateral node dissection with concomitant pelvic autonomic nerve preservation [PANP] for rectal cancer

Lateral node dissection for advanced rectal cancer, in which perirectal tissues are widely removed and superior as well as lateral nodes are dissected has contributed to improve the local failure and survival. Nevertheless urinary and sexual dysfunction frequently occur after lateral node dissection because of the damage of the intrapelvic nerves. A total of 31 male patients underwent lateral node dissection, 15 patients were eligible for the technique while 16 patients did not receive [PANP]. All the patients responded to standardized questionnaire regarding the current and preoperative urinary sexual function as well as follow-up examination six months after surgery. Regarding the bladder function, 10 patients out of 15 [67%] who were offered [PANP] maintained good urinary control p<0.04, compared to 5 patients out of 16 [19%] in the group that was not submitted to [PANP]. Regarding the sexual function, 9 patients out of 15 [60%] with [PANP] maintained satisfactory erection p<0.04, compared to 4 patients out of 16 [25%] who were not submitted to PANP]. Ejaculation was achieved in 2 patients out of 15 [13%] with [PANP], compared to 0% in the group without [PANP]. Lateral node dissection with either partial or complete [PANP] combines the curative benefit of enhanced perirectal tissue excision with a minium of voiding and sexual dysfunction in the majority of advanced rectal cancer patients

outcome of sphincter-saving resection and abdomino-perineal resection for distal rectal cancer

The advent of surgical techniques has enabled more patients with mid and low rectal cancer to have sphincter saving resections [SSR]. This procedure, however has provoked doubts regarding the adequacy of resection and fear of increased rates of recurrence compared with Abdomino-perineal resection [APR]. The introduction of Total Mesorectal Excision [TME] has much lowered the recurrence rate to nearly 4%. This study was performed to compare the oncological results of SSR for low and mid rectal cancer patients with those obtained APR before that period. A total of one hundred and fifteen patients [115] were enrolled in this study. The tumours were located between 3-12cm from anal verge. Fifty one patients [45%] underwent SSR between the years 2002-2007. The incidence of recurrence after radical SSR was compared with the historical control group of sixty patients [52%] which underwent APR. The two groups being matched for Duke's stage and tumour location. Four patients had local treatment. The mean follow-up period of patients was 2.3 years, range [1-5] years. After 2 years follow-up, the local recurrence cumulative rate was 10.3% after SSR and 16.5% after APR. Distant recurrence rates were 15% and 20% respectively. Six patients [12%] died of their disease within 2 years of radical SSR, nine patients [15%] after radical APR. The overall 5 years actuarial survival in the SSR group was 70.2% compared to 64% in the retrospective matched control group who underwent APR. SSR for mid and low rectal tumours appears to have a superior outcome over APR since there is no risk of increased recurrent disease compared to APR after an equivalent follow-up period