Impact of lateral pelvic lymph node dissection on evacuatory and urinary functions following low anterior resection for advanced rectal carcinoma
- 176 Downloads
Background and aim
Lateral pelvic lymph node dissection (LPLD) has been reported to be beneficial in terms of survival for locally advanced low rectal carcinoma. However, the impact of LPLD on bowel function has not yet been determined by means of anorectal physiologic investigation.
Patients and methods
Fifty-seven rectal cancer patients who underwent low anterior resection were evaluated with clinical and physiologic parameters. Of these, 15 patients had LPLD. The postoperative bowel and urinary function were evaluated with patients’ questionnaire and anorectal manometry before and after the operation.
The proportion of patients who had pouch reconstruction, adjuvant radiation therapy, and autonomic nerve dissection were significantly higher in the LPLD group. The incidence of evacuatory dysfunction was significantly higher (80% vs 45%) postoperatively in the LPLD group. There was no significant difference in anal sphincter pressures, sensory threshold, and neorectal volumes between the groups postoperatively. In terms of urinary function, use of medication for urination was significantly frequent in the LPLD group. Multivariate analysis identified the level of anastomosis as an independent affecting factor for evacuatory dysfunction and LPLD for urinary dysfunction.
Although LPLD affected urinary dysfunction, it did not impair postoperative evacuatory function in the early postoperative period.
KeywordsRectal cancer Lateral pelvic lymph node dissection Evacuation
- 1.Hojo K, Koyama Y, Moriya Y (1982) Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 144:350–354Google Scholar
- 3.Havenga K, Enker WE, Norstein J, Moriya Y, Heald R, Houwelingen HC, van de Velde CJ (1999) Improved survival and local control after mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 25:368–374CrossRefPubMedGoogle Scholar
- 5.Fujita S, Yamamoto S, Akasu T, Moriya Y (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90:1580–1585Google Scholar
- 8.Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, Sawada T (2002) Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44:1274–1280Google Scholar
- 9.Matsuoka H, Nakamura A, Masaki T, Sugiyama M, Hachiya Y, Atomi Y (2003) A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma. Am J Surg 185:556–559Google Scholar
- 23.Kusunoki M, Shoji Y, Yanagi H, Hatada T, Fujita S, Sakanoue Y, Yamamura T, Utsunomiya J (1991) Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis. Br J Surg 78:1434–1438Google Scholar
- 24.Yamana T, Oya M, Komatsu J, Takase Y, Mikuni N, Ishikawa H (1999) Preoperative anal sphincter high pressure zone, maximum tolerable volume, and anal mucosal electrosensitivity predict early postoperative defecatory function after low anterior resection for rectal cancer. Dis Colon Rectum 42:1145–1151PubMedGoogle Scholar
- 30.Romanos J, Stebbing JF, Smilgin Humphreys MM, Takeuchi N, Mortensen NJM (1996) Ambulatory manometric examination in patients with a colonic J pouch and in normal controls. Br J Surg 83:1744–1746Google Scholar