Advertisement

International Journal of Clinical Oncology

, Volume 11, Issue 5, pp 339–343 | Cite as

Function preservation in rectal cancer surgery

  • Yoshihiro Moriya
REVIEW ARTICLE

Abstract

When total mesorectal excision (TME) is accurately performed, dysfunction, theoretically, does not occur. However, there are differences among individuals in the running patterns and the volumes of nerve fibers, and if obesity or a narrow pelvis is present, nerve identification is difficult. Currently, the rate of urinary dysfunction after rectal surgery ranges from 33% to 70%. Many factors other than nerve preservation play a role in minor incontinence. Male sexual function shows impotence rates ranging from 20% to 46%, while 20%–60% of potent patients are unable to ejaculate. In women, information on sexual function is not easily obtained, and there are more unknown aspects than in men. As urinary, sexual, and defecation dysfunction due to adjuvant radiotherapy have been reported to occur at a high frequency, the creation of a protocol that enables analysis of long-term functional outcome will be essential for future clinical trials. In the treatment of rectal cancer, surgeon-related factors are extremely important, not only in achieving local control but also in preserving function. This article reviews findings from recent studies investigating urinary, sexual, and defecation dysfunction after rectal cancer surgery and discusses questions to be studied in the future.

Key words

rectal cancer urinary, sexual, defecation dysfunction adjuvant radiotherapy quality of life in rectal cancer patients 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gunderson, LL, Sosin, H 1974Area of failure found at reoperation following ‘curative surgery’ for adenocarcinoma of the rectumCancer3412781292PubMedCrossRefGoogle Scholar
  2. 2.
    Pilipsen, SJ, Heilweil, M, Quan, SH,  et al. 1984Patterns of pelvic recurrence following definitive resection of rectal cancerCancer5313541362CrossRefGoogle Scholar
  3. 3.
    Heald, RJ, Husband, EM, Ryall, DH 1982The mesorectum in rectal cancer surgery – the clue to pelvic recurrence?Br J Surg69613616PubMedGoogle Scholar
  4. 4.
    MacFarlane, JK, Ryll, RD, Heald, RJ 1993Mesorectal excision for rectal cancerLancet341457460PubMedCrossRefGoogle Scholar
  5. 5.
    (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 336:980–987Google Scholar
  6. 6.
    Kapiteijn, E, Marijnen, CA, Nagtegaal, ID,  et al. 2001Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med345638646PubMedCrossRefGoogle Scholar
  7. 7.
    Moriya, Y, Hojo, K, Sawada, T,  et al. 1989Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflectionDis Colon Rectum32307315PubMedGoogle Scholar
  8. 8.
    Steup, WH, Moriya, Y, van de Velde,  2002Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastasesEur J Cancer38911918PubMedCrossRefGoogle Scholar
  9. 9.
    Scholefield, JH, Steup, WH 1992Surgery for rectal cancer in JapanLancet3401101PubMedCrossRefGoogle Scholar
  10. 10.
    Matuoka, N, Moriya, Y, Akasu, T,  et al. 2001Long-term outcome of urinary function after extended lymphadenectomy in patients with distal rectal cancerEur J Surg Oncol27165169CrossRefGoogle Scholar
  11. 11.
    Moriya, Y, Sugihara, K, Akasu, T,  et al. 1995Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancerEur J Cancer31A12291232PubMedCrossRefGoogle Scholar
  12. 12.
    Mori, T, Takahashi, K, Yasuno, M 1998Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissectionLangenbecks Arch Surg383409415PubMedCrossRefGoogle Scholar
  13. 13.
    Takahashi, T, Ueno, M, Azekura, K,  et al. 2000Lateral node dissection and total mesorectal excision for rectal cancerDis Colon Rectum43S5968PubMedCrossRefGoogle Scholar
  14. 14.
    Sato, K, Sato, T 1991The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fasciaSurg Radiol Anat131722PubMedCrossRefGoogle Scholar
  15. 15.
    Leveckis, L, Boucher, NR, Parys, BT,  et al. 1995Bladder and erectile dysfunction before and after surgery for rectal cancerBr J Urol76752756PubMedGoogle Scholar
  16. 16.
    Fowler, JW, Brenner, DN, Moffat, LEF,  et al. 1978The incidence and consequence of damage to the parasympathetic nerve supply to the bladder after abdominoperineal resection of the rectum for carcinomaBr J Urol509598PubMedCrossRefGoogle Scholar
  17. 17.
    Maas, CP, Moriya, Y, Steup, WH,  et al. 2000A prospective study on radical and nerve-preserving surgery for rectal cancer in the NetherlandsEur J Surg Oncol26751757PubMedCrossRefGoogle Scholar
  18. 18.
    Havenga, K, Enker, WE, McDermott, K,  et al. 1996Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectumJ Am Coll Surg182495502PubMedGoogle Scholar
  19. 19.
    Daniel, IR, Woodward, S, Taylor, FGM,  et al. 2006Female urogenital dysfunction following total mesorectal excision for rectal cancerWorld J Surg Oncol469CrossRefGoogle Scholar
  20. 20.
    Banerjee, AK 1999Sexual dysfunction after surgery for rectal cancerLancet35319001901PubMedCrossRefGoogle Scholar
  21. 21.
    Enker, WE 1992Potency, cure, and local control in the operative treatment of rectal cancerArch Surg12713961402PubMedGoogle Scholar
  22. 22.
    Maas, K, Moriya, Y, Kenter, G,  et al. 1999A plea for preservation of the pelvic autonomic nervesLancet354772773PubMedCrossRefGoogle Scholar
  23. 23.
    Porter, GA, Soskoine, CL, Yakimets, WW,  et al. 1998Surgeon-related factors and outcome in rectal cancerAnn Surg227157167PubMedCrossRefGoogle Scholar
  24. 24.
    Beard, CJ, Lamb, C, Buswell, L,  et al. 1998Radiation-associated morbidity in patients undergoing small-field external beam irradiation for prostate cancerInt J Radiat Oncol Biol Phys41257262PubMedCrossRefGoogle Scholar
  25. 25.
    Little, DJ, Kuban, DA, Levy, LB,  et al. 2003Quality-of-life questionnaire results 2 and 3 years after radiotherapy for prostate cancer in a randomized dose-escalation studyUrology62707713PubMedCrossRefGoogle Scholar
  26. 26.
    Heriot, AG, Tekkis, PP, Fazio, VW,  et al. 2005Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancerAnn Surg242502511PubMedGoogle Scholar
  27. 27.
    Marijnen, CAM, van de Velde, CJH, Putter, H,  et al. 2005Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of multicenter randomized trialJ Clin Oncol2318471858PubMedCrossRefGoogle Scholar
  28. 28.
    Jayne, DG, Brown, JM, Thorpe, H,  et al. 2005Bladder and sexual function following resection for rectal cancer in randomized clinical trial of laparoscopic versus open techniqueBr J Surg9211241132PubMedCrossRefGoogle Scholar
  29. 29.
    Hendren, SK, O'Connor, BI, Liu, M,  et al. 2005Prevalence of male and female sexual dysfunction is high following surgery for rectal cancerAnn Surg242212223PubMedCrossRefGoogle Scholar
  30. 30.
    Schiessel, R, Karner-Hanusch, J, Herbst, F,  et al. 1994Intersphincteric resection for low rectal tumoursBr J Surg8113761378PubMedGoogle Scholar
  31. 31.
    Saito, N, Ono, M, Sugito, M,  et al. 2004Early results of intersphincteric resection for patients with very low rectal cancer. An active approach to avoid permanent colostomyDis Colon Rectum47459466PubMedCrossRefGoogle Scholar
  32. 32.
    Ueno, H, Mochizuki, H, Hashiguchi, Y,  et al. 2004Preoperative parameters expanding the indication of sphincter preserving surgery in patients with advanced low rectal cancerAnn Surg2393442PubMedCrossRefGoogle Scholar
  33. 33.
    Urban, M, Rosen, HR, Holbling, N,  et al. 2000MR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: use of intravenous and endorectal contrast materialsRadiology214503508PubMedGoogle Scholar
  34. 34.
    Bittorf, B, Stadelmaier, U, Gohl, J,  et al. 2004Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancerEur J Surg Oncol30260265PubMedCrossRefGoogle Scholar
  35. 35.
    Dahlberg, M, Glimelius, B, Graf, W,  et al. 1998Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized studyDis Colon Rectum41543549PubMedCrossRefGoogle Scholar
  36. 36.
    Marijnen, CAM, van de Velde, CJH, Putter, H,  et al. 2005Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of multicenter randomized trialJ Clin Oncol2318471858PubMedCrossRefGoogle Scholar
  37. 37.
    Gervaz, P, Rotholtz, N, Wexner, SD,  et al. 2001Colonic J-pouch function in rectal cancer patients: impact of adjuvant chemoradiotherapyDis Colon Rectum4416671675PubMedCrossRefGoogle Scholar
  38. 38.
    Temple, LK, Bacik, J, Savatta, SG,  et al. 2005The development of validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancerDis Colon Rectum4813531365PubMedCrossRefGoogle Scholar
  39. 39.
    Saha, S, Dan, AG, Bilchik, AJ,  et al. 2000Technical details of sentinel lymph node mapping in colorectal cancer and its impact on stagingAnn Surg Oncol7120124PubMedCrossRefGoogle Scholar
  40. 40.
    Bertoglio, S, Sandrucci, S, Percivale, P,  et al. 2004Prognostic value of sentinel lymph node biopsy in the pathologic staging of colorectal cancer patientsJ Surg Oncol85166170PubMedCrossRefGoogle Scholar
  41. 41.
    Engel, J, Kerr, J, Schlesinger-Raab, A,  et al. 2003Quality of life in rectal cancer patients: a 4-year prospective studyAnn Surg238203213PubMedCrossRefGoogle Scholar
  42. 42.
    Guren, MG, Eriksen, MT, Wiig, JN,  et al. 2005Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancerEur J Surg Oncol31735742PubMedCrossRefGoogle Scholar
  43. 43.
    Sprangers, MA, Schwartz, CE 1999The challenge of response shift for quality-of-life-based clinical oncology researchAnn Oncol10747749PubMedCrossRefGoogle Scholar
  44. 44.
    Guren, MG, Wiig, JN, Dueland, S,  et al. 2001Quality of life in patients with urinary diversion after operation for locally advanced rectal cancerEur J Surg Oncol27645651PubMedCrossRefGoogle Scholar

Copyright information

© The Japan Society of Clinical Oncology 2006

Authors and Affiliations

  1. 1.Colorectal Surgery DivisionNational Cancer Center HospitalTokyoJapan

Personalised recommendations