title: Long-term survival and recurrences after total nerve-sparing surgery for rectal cancer.
abstract: OBJECTIVE
  In advanced extraperitoneal rectal cancer Japanese surgeons perform the lateral pelvic nodal dissection with only partial pelvic autonomic nerves preservation; instead most Western surgeons prefer the total mesorectal excision (TME) with complete pelvic nerve sparing except for evident neoplastic nervous involvement. Long-term oncological results of the total nerve-sparing TME are reported.
  
  
  METHODS
  From January 1992 to October 1998 71 [corrected] patients with extraperitoneal rectal carcinoma underwent TME with total nerve sparing except in two cases in which only a partial sparing was possible because of macroscopic neoplastic nervous infiltration: 54 anterior resections and 17 abdominoperineal resections were performed. Sixty-one curatively operated patients (9 stage I, 20 stage II, 29 stage III and 3 stage IV) were included.
  
  
  RESULTS
  No postoperative death occurred. Postoperative radiochemotherapy was performed in 31 cases, radiotherapy in 9 cases and chemotherapy in 9 cases. The mean follow-up was 98.7 months. The 5-year overall and disease-free survival rates were 88.8% and 77.7%, 90% and 75.1%, 62.3% and 45% for stage I, II and III respectively. The 8-year actuarial overall and disease-free survival rates were 77.7% and 77.7%, 78.3% and 75.1%, 50.4% and 40% for stage I, II and III respectively. Local failures with or without distant metastases were 6 (9.8%).
  
  
  CONCLUSIONS
  Total nerve-sparing surgery is not contraindicated unless grossly neoplastic involvement is present.
authors.affiliation: Department of Surgical Sciences, La Sapienza University, Rome, Italy. nadia.peparini@uniroma1.it
authors.forename: Nadia
authors.initials: N
authors.lastname: Peparini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Maturo
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Di Matteo
authors.forename: Rita
authors.initials: R
authors.lastname: Mele
authors.forename: Fabio
authors.initials: F
authors.lastname: Benedetti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Di Matteo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017776:Autonomic Pathways / Q000601:surgery*; D002277:Carcinoma / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011183:Postoperative Complications / Q000175:diagnosis; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D012007:Rectum / Q000294:innervation* / Q000601:surgery; D016896:Treatment Outcome