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Male Urinary and Sexual Functions After Mesorectal Excision Alone or in Combination with Extended Lateral Pelvic Lymph Node Dissection for Rectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Mesorectal excision reduced the incidence of genitourinary dysfunction compared with conventional surgery. In Japan, extended lateral pelvic lymph node dissection (ELD) is added to mesorectal excision when lateral pelvic node metastasis is suspected. The aim of this study was to evaluate male genitourinary function after mesorectal excision or mesorectal excision plus ELD for rectal cancer.

Methods

According to the degree of pelvic-plexus preservation (PPP) and ELD, patients were grouped into PG1, mesorectal excision alone (bilateral PPP without ELD) (n = 27); PG2, bilateral PPP with ELD (n = 12); PG3, unilateral PPP with ELD (n = 26); and PG4, no PPP with ELD (n = 4). The assessment included measurements of the time interval to residual urine becoming <50 mL, interviews assessing sexual function, and nocturnal penile tumescence measurements.

Results

Proportions of patients with residual urine becoming <50 mL within 14 days after surgery were 96% in PG1, 73% in PG2, 23% in PG3, and 0% in PG4 (P < .001). Proportions of patients answering the ability to maintain sexual intercourse at 1 year were 95% in PG1, 56% in PG2, 45% in PG3, and 0% in PG4 (P < .001). Proportions of patients having nocturnal penile rigidity of >65% at 1 year were 95% in PG1, 33% in PG2, 50% in PG3, and 0% in PG4 (P < .001).

Conclusions

Patients undergoing mesorectal excision alone can expect excellent genitourinary function, but functional results after mesorectal excision plus ELD are far worse. Degrees of dysfunction depend on the extents of both autonomic nerve resection and ELD.

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Acknowledgment

This study was supported in part by a grant-in-aid for Clinical Research for Evidence Based Medicine, a grant-in-aid for Cancer Research from the Ministry of Health, Labour, and Welfare, and a grant from the Foundation for Promotion of Cancer Research in Japan.

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Authors and Affiliations

  1. Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan

    Takayuki Akasu MD & Yoshihiro Moriya MD

  2. Department of Surgical Oncology, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan

    Kenichi Sugihara MD

Authors
  1. Takayuki Akasu MD
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  2. Kenichi Sugihara MD
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  3. Yoshihiro Moriya MD
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Correspondence to Takayuki Akasu MD.

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Akasu, T., Sugihara, K. & Moriya, Y. Male Urinary and Sexual Functions After Mesorectal Excision Alone or in Combination with Extended Lateral Pelvic Lymph Node Dissection for Rectal Cancer. Ann Surg Oncol 16, 2779–2786 (2009). https://doi.org/10.1245/s10434-009-0546-x

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  • DOI: https://doi.org/10.1245/s10434-009-0546-x

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