PRESERVATION OF URINE VOIDING AND SEXUAL FUNCTION AFTER RECTAL-CANCER SURGERY

被引:232
作者
HOJO, K
VERNAVA, AM
SUGIHARA, K
KATUMATA, K
机构
[1] NATL CANC CTR,DEPT SURG,TOKYO 104,JAPAN
[2] ST LOUIS UNIV,SCH MED,DEPT SURG,ST LOUIS,MO 63104
关键词
RECTAL CANCER; POSTOPERATIVE VOIDING AND SEXUAL FUNCTION; PELVIC AUTONOMIC NERVE PRESERVATION; EXTENDED LYMPHADENECTOMY;
D O I
10.1007/BF02049890
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
In order to decrease the urinary and sexual morbidity which follows radical pelvic lymphadenectomy for rectal cancer, we began selective preservation of the pelvic autonomic nerves. Between 1985 and 1987, 134 patients with rectal cancer underwent a curative resection (52 abdominoperineal resections, 82 sphincter-saving resections) with extended pelvic lymphadenectomy and selective pelvic autonomic nerve preservation (PANP). PANP was classified into five degrees depending on the extent of pelvic dissection. First-degree PANP indicates complete preservation of the nerves; second-degree PANP indicates destruction of the hypogastric plexus; third-degree PANP indicates partial preservation of the pelvic autonomic plexus; fourth-degree PANP indicates bilateral or unilateral preservation of only the fourth pelvic parasympathetic nerve; and fifth-degree PANP indicates complete destruction of the pelvic autonomic nerves. Most patients with first-degree PANP were able to spontaneously void 7-10 days following the operation. However, 78 percent (28/36) of patients with fifth-degree PANP had not regained bladder sensation by the third postoperative week and were discharged with an indwelling catheter; 58 percent (21/36) had not regained bladder sensation by the 60th postoperative day. The cystometric data indicate a progressive decline in bladder sensation and function with increasingly extensive pelvic dissection. However, preservation of only the fourth parasympathetic nerve (fourth-degree PANP) resulted in partial sparing of bladder sensation and voiding function. Evaluation of sexual function in males under 60 years of age revealed that only 31 percent (12/39) recovered erectile function and only 19 percent (6/39) recovered normal ejaculatory function in the first postoperative year. Most of these patients had complete preservation of their pelvic autonomic plexus (i.e., first-degree PANP). Four patients with partial PANP have recovered erectile function. Complete PANP is the best way to prevent urinary and sexual morbidity after rectal resection. The opposing goals of maximizing the chance for cure and minimizing morbidity must be individualized and balanced in each patient. Our data demonstrate that it is now possible to perform radical pelvic lymphadenectomy in the majority of patients with advanced rectal cancer with a minimum of voiding dysfunction. Preservation of sexual function in males is more difficult and depends on complete PANP and, as such, should be restricted to the group of patients with Dukes' A and B carcinomas.
引用
收藏
页码:532 / 539
页数:8
相关论文
共 11 条
  • [1] AAGAARD J, 1986, SURGERY, V99, P564
  • [2] SEXUAL DYSFUNCTION FOLLOWING OPERATION FOR CARCINOMA OF THE RECTUM
    BALSLEV, I
    HARLING, H
    [J]. DISEASES OF THE COLON & RECTUM, 1983, 26 (12) : 785 - 788
  • [3] RISK-FACTORS FOR DEVELOPING VOIDING DYSFUNCTION AFTER ABDOMINO-PERINEAL RESECTION FOR ADENOCARCINOMA OF THE RECTUM
    BURGOS, FJ
    ROMERO, J
    FERNANDEZ, E
    PERALES, L
    TALLADA, M
    [J]. DISEASES OF THE COLON & RECTUM, 1988, 31 (09) : 682 - 685
  • [4] MALE SEXUAL FUNCTION AFTER ABDOMINO-PERINEAL RESECTION FOR RECTAL-CANCER
    DANZI, M
    FERULANO, GP
    ABATE, S
    CALIFANO, G
    [J]. DISEASES OF THE COLON & RECTUM, 1983, 26 (10) : 665 - 668
  • [5] GESTENBERG TC, 1980, ANN SURG, V191, P81
  • [6] THE EFFECTIVENESS OF WIDE ANATOMICAL RESECTION AND RADICAL LYMPHADENECTOMY FOR PATIENTS WITH RECTAL-CANCER
    HOJO, K
    KOYAMA, Y
    [J]. JAPANESE JOURNAL OF SURGERY, 1982, 12 (02): : 111 - 116
  • [7] AN ANALYSIS OF SURVIVAL AND VOIDING, SEXUAL FUNCTION AFTER WIDE ILIOPELVIC LYMPHADENECTOMY IN PATIENTS WITH CARCINOMA OF THE RECTUM, COMPARED WITH CONVENTIONAL LYMPHADENECTOMY
    HOJO, K
    SAWADA, T
    MORIYA, Y
    [J]. DISEASES OF THE COLON & RECTUM, 1989, 32 (02) : 128 - 133
  • [8] BLADDER AND SEXUAL FUNCTION AFTER SURGERY FOR RECTAL-CANCER
    KINN, AC
    OHMAN, U
    [J]. DISEASES OF THE COLON & RECTUM, 1986, 29 (01) : 43 - 48
  • [9] LEE JF, 1973, ARCH SURG-CHICAGO, V107, P324
  • [10] MORTALITY, MORBIDITY, AND PATTERNS OF RECURRENCE AFTER ABDOMINO-PERINEAL RESECTION FOR CANCER OF THE RECTUM
    ROSEN, L
    VEIDENHEIMER, MC
    COLLER, JA
    CORMAN, ML
    [J]. DISEASES OF THE COLON & RECTUM, 1982, 25 (03) : 202 - 208