Long-term survival and recurrences after total nerve-sparing surgery for rectal cancer.
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.
Peparini
Nadia
N
Department of Surgical Sciences, La Sapienza University, Rome, Italy. nadia.peparini@uniroma1.it
Maturo
Alessandro
A
Di Matteo
Filippo Maria
FM
Mele
Rita
R
Benedetti
Fabio
F
Di Matteo
Giorgio
G
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