Feasibility of autonomic nerve-preserving surgery for advanced rectal cancer based on analysis of micrometastases.
BACKGROUND
Autonomic nerve preservation has been advocated as a means of preserving urinary and sexual function after surgery for rectal cancer, but may compromise tumour clearance. The aim of this study was to determine the incidence of micrometastasis in the connective tissues surrounding the pelvic plexus.


METHODS
The study included 20 consecutive patients who underwent rectal surgery with bilateral lymph node dissection for advanced cancer. A total of 78 connective tissues medial and lateral to the pelvic plexus and 387 lymph nodes were sampled during surgery. All connective tissue samples and 260 lymph nodes were examined for micrometastases by reverse transcriptase-polymerase chain reaction (RT-PCR) after operation. All patients were followed prospectively for a median of 36.0 months.


RESULTS
Of 245 histologically negative lymph nodes, 38 (15.5 per cent) were shown by RT-PCR to harbour micrometastases. However, micrometastases to tissues surrounding the pelvic plexus were detected in only two (3 per cent) of 78 tissues, that is in two of 20 patients. Clinical follow-up showed that the two patients had a poor prognosis owing to distant metastases.


CONCLUSIONS
Autonomic nerve-preserving surgery may be feasible for advanced rectal cancer, but study of more patients positive for micrometastases is required.
Matsumoto
T
T
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan.
Ohue
M
M
Sekimoto
M
M
Yamamoto
H
H
Ikeda
M
M
Monden
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017776:Autonomic Pathways; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007001:Hypogastric Plexus; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009372:Neoplasms, Connective Tissue / Q000175:diagnosis / Q000556:secondary*; D010386:Pelvic Neoplasms / Q000175:diagnosis / Q000556:secondary*; D011379:Prognosis; D011446:Prospective Studies; D012333:RNA, Messenger / Q000032:analysis; D012334:RNA, Neoplasm / Q000032:analysis; D012004:Rectal Neoplasms / Q000601:surgery*; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods
D012333:RNA, Messenger; D012334:RNA, Neoplasm