Objective： Preservation of the pelvic autonomic nerves in order to lower bladder and sexual dysfunction after radical rectal cancer surgery ＆ to evaluate functional outcome, local recurrence. Methods： A prospective...Objective： Preservation of the pelvic autonomic nerves in order to lower bladder and sexual dysfunction after radical rectal cancer surgery ＆ to evaluate functional outcome, local recurrence. Methods： A prospective study was under- taken on Egyptian patients. Forty one patients participated in the study in the period from December 2002 till June 2004 where they underwent radical surgery but with preservation of the pelvic autonomic nerves this was followed by adjuvant pelvic radiotherapy. Results： Six months, 1-year and 2-year follow-up of urinary function was complete in 32 out of 41 （78%）, 30 out of 41 （73%） and 27 out of 41 patients （65%） respectively There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunction. None of the patients reported major incontinence. Six months, 1-year and 2-year follow-up of sexual function revealed that 22 out of 41 patients （53%） were sexually active. Three out of 41 patients （7.3%） developed local recurrence. 38 （92.7%） patients were free of local recurrence, regarding pa- tients who received adjuvant radiotherapy 3 out of the 34 （8.8%） patients developed local pelvic recurrence while 9 patients （26.5%） developed distant metastases （3 of them did not receive adjuvant chemotherapy）, while patients who received adju- vant chemotherapy, 2 out of 20 patients （10%） developed local recurrence while distant metastases developed in 6 patients （30%）. Conclusion： Preservation of the pelvic autonomic nerves minimizes bladder and sexual dysfunction especially in male patients after rectal cancer surgery.展开更多
The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results.However,the incidence of bladder and se...The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results.However,the incidence of bladder and sexual dysfunction remains high.This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur.The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes.In this review,we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle,the lateral pelvic wall and dissection around the urogenital organs.Surgical techniques in these areas are discussed.We also discuss the results in functional outcomes of the various techniques including open,laparoscopic and robotic over the last 30 years.展开更多
文摘Objective： Preservation of the pelvic autonomic nerves in order to lower bladder and sexual dysfunction after radical rectal cancer surgery ＆ to evaluate functional outcome, local recurrence. Methods： A prospective study was under- taken on Egyptian patients. Forty one patients participated in the study in the period from December 2002 till June 2004 where they underwent radical surgery but with preservation of the pelvic autonomic nerves this was followed by adjuvant pelvic radiotherapy. Results： Six months, 1-year and 2-year follow-up of urinary function was complete in 32 out of 41 （78%）, 30 out of 41 （73%） and 27 out of 41 patients （65%） respectively There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunction. None of the patients reported major incontinence. Six months, 1-year and 2-year follow-up of sexual function revealed that 22 out of 41 patients （53%） were sexually active. Three out of 41 patients （7.3%） developed local recurrence. 38 （92.7%） patients were free of local recurrence, regarding pa- tients who received adjuvant radiotherapy 3 out of the 34 （8.8%） patients developed local pelvic recurrence while 9 patients （26.5%） developed distant metastases （3 of them did not receive adjuvant chemotherapy）, while patients who received adju- vant chemotherapy, 2 out of 20 patients （10%） developed local recurrence while distant metastases developed in 6 patients （30%）. Conclusion： Preservation of the pelvic autonomic nerves minimizes bladder and sexual dysfunction especially in male patients after rectal cancer surgery.
文摘The advent of total mesorectal excision(TME)together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results.However,the incidence of bladder and sexual dysfunction remains high.This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur.The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes.In this review,we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle,the lateral pelvic wall and dissection around the urogenital organs.Surgical techniques in these areas are discussed.We also discuss the results in functional outcomes of the various techniques including open,laparoscopic and robotic over the last 30 years.
