| Theme |
Up-to-date Therapuetic Strategy for Advanced Colorectal Cancer |
| Title |
Strategy of the Treatment for Lower Rectal Cancer-Autonomic Nervous System Preserving Operation Maintaining Postoperative Urinary Function and Sexual Ability of Patients |
| Author |
Masamichi Yasuno |
Department of Surgery, Tokyo Metropolitan Komagome Hospital |
| Author |
Takeo Mori |
Department of Surgery, Tokyo Metropolitan Komagome Hospital |
| [ Summary ] |
Lateral lymph node metastases occur in about 10% of lower rectal cancer patients. Therefore, radical lateral lymph node dissection is necessary to control local failure in the pelvis after lower rectal cancer operations. It is also important to preserve the pelvic autonomic nervous system with lateral lymph node dissection, to maintain postoperative urinary function and sexual ability of patients. Since 1987, we have performed autonomic nerve preserving resection on patients with advanced rectal cancer. The local recurrence rate after autonomic nerve-preserving operations is under 5%. Therefore, we concluded that the cure rate from autonomic nerve preserving operations is the same as that for conventional operations with resection of the autonomic nervous system. Preserving the unilateral autonomic nervous system is necessary to maintain good post operative urinary function. It is difficult to maintain postoperative erectile and ejaculatory abilities in patients who have received lateral lymph node dissection. Only 20-30% of patients in whom the unilateral autonomic nervous system was preserved, and 50% of the patients whose bilateral autonomic nervous systems were preserved, maintained their sexual ability. We propose the use of bilateral autonomic nerve preserving operations, with lateral lymph node dissection, for those patients with advanced lower rectal cancer. This operation is beneficial to maintain both cure rates and postoperative urinary and sexual functions. |