Prognosis and postoperative genital function of function-preservative surgery of pelvic autonomic nerve preservation for male rectal cancer patients.

Zhihua Liu,Lei Wang,Meijin Huang,Liang Kang,Ji Cui,Ping Lan,Jianping Wang

doi:10.1186/s12893-016-0127-4

Abstract

BackgroundTo retrospectively evaluate postoperative genital function, local recurrence rate and survival rate after total mesorectal excision (TME) combined with or without pelvic autonomic nerve preservation (PANP) in male patients with rectal cancer.MethodsA total of 953 male patients with rectal cancer after TME (518 patients received TME combined with PANP [PANP group] and 434patients received TME alone [TME group]) were included. Assessments of postoperative genital function, local recurrence rate, and 5 year survival rate were collected.ResultsRate of erection dysfunction in PANP group (41.9 %) was significantly lower than that in TME group (76.7 %, P < 0.05). Rate of ejaculation dysfunction in PANP group (42.5 %) was also significantly lower than that in TME group (67.3 %, P < 0.05). Local recurrence rate (P = 0.66) and survival rate (P = 0.26) did not differ between the two groups. For patients with preoperative obstruction, local recurrence rate was significantly higher (P = 0.01) and survival rate significantly lower (P = 0.03) in PANP group.ConclusionsPANP surgery has significant advantage with respect to preservation of genital function and should be recommended as surgical treatment for rectal cancer patients. However, PANP surgery should be considered with caution in patients with preoperative obstruction in view of the poorer long-term outcomes in these patients.

Highlights

To retrospectively evaluate postoperative genital function, local recurrence rate and survival rate after total mesorectal excision (TME) combined with or without pelvic autonomic nerve preservation (PANP) in male patients with rectal cancer
434 patients received TME surgery and 518 patients received TME combined with PANP surgery (PANP group)
Our results indicated that postoperative local recurrence rate and 5 year survival rate did not differ significantly between PANP group and control group, indicating that PANP technique has comparable long-term outcomes

Summary

Introduction

To retrospectively evaluate postoperative genital function, local recurrence rate and survival rate after total mesorectal excision (TME) combined with or without pelvic autonomic nerve preservation (PANP) in male patients with rectal cancer. It has been estimated that over one million patients are diagnosed with colorectal cancer (CRC) every year, along with 500,000 related deaths in the world [1, 2]. The epidemiological characteristics of CRC in Chinese patients, known as “three high and one low” [9, 10], present as a severe threat [11]. These include high proportion of rectal cancer (RC, about 60 %), high proportion of distal RC (about 65–70 %), and high proportion of young patients (10–15 % of patients less than 30 years old), and low early diagnostic rate (less than 10 %) [12]. Low position of RC tumor increase ssurgical difficulty andyoung age raises the issue of genital function preservation

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