RESUMO
The goal of this study was to evaluate the practicability of Total mesorectal excision [TME] and Autonomic nerve preservation [ANP] for patients with rectal cancer, together with their impact on local failure rates and urinary and sexual functions. Surgery for rectal cancer continues to develop towards the ultimate goals of improving local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary and sexual function. During the planning and conduct of a radical operation for rectal cancer, a number of surgical issues have recently emerged and should be considered. These include: [1] TME; [2] ANP; [3] circumferential resection margin [CRM]; [4] distal resection margin [DRM] and [5] postoperative quality of life. This study was conducted between May 2002 and October 2006 at the department of surgery of the National Cancer Institute and included 50 patients with mid- and low-rectal cancer. Their mean age was 43.7 years. They were 17 males and 33 females. Tumors of the middle 1/3 of the rectum accounted for 54% of cases while those of the lower 1/3 represented 46%. Twenty seven patients had Low anterior resection [LAR] while 23 had Abdomino-perineal resection [APR], all of them with curative intent. These patients were divided into two groups: group A that included 30 patients subjected to subtotal mesorectal excision and that were studied retrospectively and group B that included 20 patients subjected to TME with ANP. Patients were followed up for a period ranging from 6 to 35 months with a median period of 13 months. In group B, median operative duration increased by 45 minutes in LAR and 30 minutes in APR. Blood loss and hospital stay were also higher in group B. Wider CRM and DRM could be achieved in group B. In group A, 20% developed local recurrence of their disease while none of the patients of group B showed recurrence. The postoperative complication rate in group A was 20% whereas in group B it rose to 45%. Postoperatively, 50% of patients in group A and only 15% in group B expressed urinary dysfunction. Abnormal uroflowmetry parameters were found in 33.3% of patients in group A and only 10% of patients in group B. Maintained sexual activity after surgery was noted in only 50% patients in group A while in group B it was maintained in 80% of them. TME with ANP is a tedious procedure requiring painstaking training and it is associated with a higher morbidity rate. Nevertheless the advantages of this technique are so evident as regards the decrease in local recurrence rates and the improvement in voiding and sexual functions that it deserves to be considered as the standard treatment for these tumors