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Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring—a Prospective 2-Year Follow-Up Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Aim

Urogenital dysfunction is a common sequela following total mesorectal excision for rectal cancer. This prospective study analyzed potential risk factors and investigated the impact of pelvic intraoperative neuromonitoring.

Method

Included were 85 patients undergoing total mesorectal excision for rectal cancer, 43 under the control of pelvic intraoperative neuromonitoring. Urogenital function was assessed with validated questionnaires within a 2-year follow-up period. Potential risk factors were identified by multivariate analysis.

Results

Overall, approximately one-third of treated patients suffered from new onset of urinary dysfunction. Initially, half of the sexually active patients were affected by sexual dysfunction; after 2 years, almost three quarters were affected. In the pelvic intraoperative neuromonitoring group, urinary and sexual dysfunction rates including minor and major disturbances were significantly lower (2-year follow-up 20% vs. 51% (p = 0.004) and 56% vs. 90% (p = 0.010)). Throughout the survey, non-performance of pelvic intraoperative neuromonitoring was found to be an independent risk factor. Neoadjuvant chemoradiotherapy was identified as an independent predictor for urogenital dysfunction in the further course one and 2 years after surgery.

Conclusion

Pelvic intraoperative neuromonitoring is associated with significantly lower rates of urinary and sexual dysfunction in the short and long run, whereas neoadjuvant chemoradiotherapy has a negative impact only in the long run.

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Author Contribution

Contributions to conception and design—Kauff, Kneist.

Acquisition, analysis, and interpretation of data—Kauff, Lang, Kneist.

Drafting the work—Kauff, Kneist.

Critical revision—Kauff, Lang, Kneist.

Final approval—Kauff, Lang, Kneist.

Agreement to be accountable for all aspects of the work—Kauff, Lang, Kneist.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

    Daniel W. Kauff, Hauke Lang & Werner Kneist

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  1. Daniel W. Kauff
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  2. Hauke Lang
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  3. Werner Kneist
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Correspondence to Daniel W. Kauff.

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Kauff, D.W., Lang, H. & Kneist, W. Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring—a Prospective 2-Year Follow-Up Study. J Gastrointest Surg 21, 1038–1047 (2017). https://doi.org/10.1007/s11605-017-3409-y

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  • DOI: https://doi.org/10.1007/s11605-017-3409-y

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