Impact of lateral pelvic lymph node dissection on evacuatory and urinary functions following low anterior resection for advanced rectal carcinoma.
OBJECTIVE
Lateral pelvic lymph node dissection (LPLD) has been reported to be beneficial in terms of survival for locally advanced low rectal carcinoma. However, the impact of LPLD on bowel function has not yet been determined by means of anorectal physiologic investigation.


METHODS
Fifty-seven rectal cancer patients who underwent low anterior resection were evaluated with clinical and physiologic parameters. Of these, 15 patients had LPLD. The postoperative bowel and urinary function were evaluated with patients' questionnaire and anorectal manometry before and after the operation.


RESULTS
The proportion of patients who had pouch reconstruction, adjuvant radiation therapy, and autonomic nerve dissection were significantly higher in the LPLD group. The incidence of evacuatory dysfunction was significantly higher (80% vs 45%) postoperatively in the LPLD group. There was no significant difference in anal sphincter pressures, sensory threshold, and neorectal volumes between the groups postoperatively. In terms of urinary function, use of medication for urination was significantly frequent in the LPLD group. Multivariate analysis identified the level of anastomosis as an independent affecting factor for evacuatory dysfunction and LPLD for urinary dysfunction.


CONCLUSIONS
Although LPLD affected urinary dysfunction, it did not impair postoperative evacuatory function in the early postoperative period.
Matsuoka
Hiroyoshi
H
The Department of Surgery, School of Medicine, Kyorin University, Tokyo, Japan. Hiroelvis@aol.com
Masaki
Tadahiko
T
Sugiyama
Masanori
M
Atomi
Yutaka
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003672:Defecation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000009:adverse effects; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000209:etiology*