Preliminary results of pelvic autonomic nerve-preserving surgery combined with intraoperative and postoperative radiation therapy for patients with low rectal cancer.
BACKGROUND
In Japan, lateral lymphadenectomy was widely performed for patients with stage II-III rectal tumors because it was thought to contribute to good local control, but the pelvic autonomic nerves were thus sacrificed. Although autonomic nerve-sparing surgery with lateral lymph node dissection has been tried from around 1987, the type of nerve sparing varied and the indications were not established. To examine the possibility of expanding the indications for total pelvic autonomic nerve preservation for patients with low rectal cancer, we conducted a pilot study.


METHODS
Between 1993 and 1997, a total of 50 patients with low rectal cancer underwent pelvic autonomic nerve preservation with lateral lymphadenectomy of both sides and intraoperative radiation therapy followed by postoperative radiation therapy.


RESULTS
The median follow-up period for surviving patients was 41 months. The 3-year local control rates for all patients, with stage I-II and stage III tumors were 88% (95% confidence interval, 78-97%), 97% (90-100%) and 73% (52-94%), respectively. The site of local recurrences was not near or within the preserved plexus.


CONCLUSIONS
The preliminary results showed good local control rate for patients with stage I-II tumors. For patients with stage III tumors, the local control rate was unsatisfactory, but nerve sparing was not the cause of local recurrence. Further investigation of function-preserving surgery without decreasing curability is needed.
Ishikura
S
S
Radiation Oncology Division, National Cancer Center Hospital East, Kashiwa, Japan. sishikur@east.ncc.go.jp
Ogino
T
T
Ono
M
M
Arai
T
T
Sugito
M
M
Shimizu
W
W
Kawashima
M
M
Imai
M
M
Ito
Y
Y
Ikeda
H
H
D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000033:anatomy & histology*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000294:innervation*; D010865:Pilot Projects; D011182:Postoperative Care; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000534:rehabilitation / Q000601:surgery*; D019529:Sexuality; D014554:Urination