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A Journal on Internal Medicine

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Panminerva Medica 2001 June;43(2):95-101

language: English

Lateral pelvic lymphadenectomy and total nerve sparing for locally advanced rectal cancer in western patients

Di Matteo G., Peparini N., Maturo A., Di Matteo F. M., Zeri K. P., Redler A., Mascagni D.

From the ­Third Depart­ment of Sur­gery, Uni­ver­sity “La Sapien­za” Pol­i­clin­i­co Umber­to I, ­Rome, Ita­ly


Back­ground. In an ­attempt to ­improve the ­results of local­ly ­advanced rec­tal can­cer treat­ment, we per­formed an extend­ed sur­gi­cal tech­nique con­sist­ing of ­total mes­o­rec­tal exci­sion (TME), lat­er­al pel­vic lym­phad­e­nec­to­my (LPL) and ­total ­nerve spar­ing (NS). Resec­tion of the auto­nom­ic ­nerves was real­ized ­only ­when ­these ­fibres ­were ­involved by the ­tumour.
Meth­ods. ­Nine cas­es (9.2%) of a per­son­al ­series of 98 west­ern ­patients ­with rec­tal car­ci­no­ma oper­at­ed on ­between Jan­u­ary 1992 and Decem­ber 1997 at ­Third Depart­ment of Sur­gery, Uni­ver­sity “La Sapien­za”, ­Rome, under­went TME, LPL and NS pro­ce­dures for local­ly ­advanced extrap­e­rit­o­neal dis­ease.
­Results. Two out of sev­en ­patients in ­stage II/III suf­fered post­op­er­a­tive­ly ­from uri­nary reten­tion ­with ­mild irreg­u­lar ­flow as test­ed on urod­y­nam­ics, but no ­long-­term uri­nary dis­tur­banc­es per­sist­ed. Ret­ro­grade ejac­u­la­tion ­occurred post­op­er­a­tive­ly in one of two ­patients who expe­ri­enced uri­nary dis­tur­banc­es. ­Another ­patient had erec­tion dys­func­tions. ­These sex­u­al dys­func­tions did not ­improve dur­ing the ­long-­term fol­low-up. Sev­en ­patients ­with ­stage II or ­stage III dis­ease ­achieved a 5-­year sur­vi­val ­rate of 80.0% and a 5-­year dis­ease-­free sur­vi­val ­rate of 68.6% ­after a ­mean fol­low-up peri­od of 64.7 ­months. ­None of ­them expe­ri­enced ­local recur­rence, but one ­patient ­died of dif­fuse met­a­stat­ic dis­ease 50 ­months ­after sur­gery. Two ­patients ­with ­stage IV rec­tal car­ci­no­ma ­died of ­local and dis­tant dis­ease 13 ­months and 35 ­months ­after oper­a­tion. One ­patient under­went liv­er resec­tion for sol­i­tary metas­ta­sis 25 ­months ­after pri­mary oper­a­tion.
Con­clu­sions. TME, LPL, and NS ­with resec­tion of auto­nom­ic ­nerves ­only ­when ­these ­fibres are ­involved by the dis­ease can ­achieve sat­is­fac­to­ry ­results in ­terms of sur­vi­val and func­tion­al out­come in select­ed west­ern ­patients ­with local­ly ­advanced rec­tal can­cer.

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