Application of laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal cancer

Yan Liu,Yan-Feng Niu,Guo-Bin Wang,Xiao-Ming Lu,Kai-Xiong Tao

doi:10.1142/s1793545816430021

Abstract

This study aimed to investigate the influence of laparoscopic total mesorectal excision combined with sphincter-preserving surgery on the postoperative defecation function, urinary function and sexual function in low or ultralow rectal cancer. A retrospective study was undertaken on 107 patients (65 laparoscopic resection and 42 laparoctomic resection) with rectal cancer undergoing laparoscopic or open laparoscopic total mesorectal excision combined with sphincter-preserving surgery from April 2009 to April 2013. The quality of life outcomes of all patients, including defection, urinary and sexual function, were assessed at 6, 12 and 24 months after operation. Gastrointestinal quality of life index (GQOLI) was used to evaluate the fecal incontinence and bowel dysfunction. Urinary and sexual functions were studied by means of questionnaires on the basis of the international prostatic symptom score (IPSS) and international index of erectile function (IIEF), respectively. In laparoscopic surgery group, there were two cases of anastomotic leakage, three cases of anastomotic stricture, seven cases of local recurrence, ten cases of hepatic metastasis and five cases of lung metastasis. The satisfaction rates of patients about their defecation function reached 60.3% (35/58, 84.5% (49/58) and 91.3% (53/58) at 6, 12, and 24 months follow-up, respectively. The assessment after one year showed that the overall incidence of urinary dysfunction was 10.7% (7/65); Among male patients, 18.4% (7/36) suffered from erectile dysfunction and 27.8% (10/36) suffered from ejaculatory dysfunction; 65.5% (19/29) female patients investigated were satisfied with their postoperative sexual life. In open surgery group, there were two cases of anastomotic leakage, two cases of anastomotic stricture, nine cases of local recurrence, ten cases of hepatic metastasis and seven cases of lung metastasis. The satisfaction rates of patients about their defecation function were 56.4% (22/39), 82.1% (32/39) and 94.8% (37/39) at 6, 12, and 24 months follow-up, respectively. The assessment after one year showed that the overall incidence of urinary dysfunction was 11.9% (5/42); 25% (4/16) male patients suffered from erectile dysfunction and 31.3% (5/16) suffered from ejaculatory dysfunction; 69.2% (19/26) female patients investigated were satisfied of their postoperative sexual life. There was no statistic difference in the two groups. Laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal carcinoma is safe and practicable. It can be helpful for enhancing the probability of anus reservation, and obtains satisfactory defecation, sexual and urinary functions.

Highlights

The radical resection of rectal carcinoma is easy to damage pelvicautonomic nerve and dysfunctions of defecation, bladder and sexual are recognized complications of rectal carcinoma resection
Studies over the past two decades have demonstrated that this procedure of total mesorectal excision (TME) for rectal cancer, combined with an awareness of the pelvic autonomic nerve pathways, has resulted in a low frequency of serious bladder and sexual dysfunction.[2,3]
Selection criteria of patients in this study were described as follows: (1) primary rectal cancer with a diameter < 2 cm located at 3–5 cm from the anal verge; (2) well or moderately di®erentiated adenocarcinoma; (3) TNM stage was T1–3N0M0 or T1– 3N1–2M0 or Tis; (4) without internal anal sphincter invasion based on the examination of magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS); (5) no-obese patient with body mass index (BMI) less than 25

Summary

Introduction

The radical resection of rectal carcinoma is easy to damage pelvicautonomic nerve and dysfunctions of defecation, bladder and sexual are recognized complications of rectal carcinoma resection. The incidences of these complications were obviously minimized after total mesorectal excision (TME) was introduced.[1] And TME has become a standard paradigm for the treatment of rectal cancer. Studies over the past two decades have demonstrated that this procedure of TME for rectal cancer, combined with an awareness of the pelvic autonomic nerve pathways, has resulted in a low frequency of serious bladder and sexual dysfunction.[2,3] accumulating evidences have indicated that laparoscopic TME for middle or low rectal cancer is technically feasible with curative outcomes similar to those for open TME.[4,5]. Bowel dysfunction and fecal incontinence are observed,[6] The urinary and sexual dysfunctions have been reported with some certain rate after operation.[7]

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