title: Intraoperative radiotherapy for oncological and function-preserving surgery in patients with advanced lower rectal cancer.
abstract: BACKGROUND
  Pelvic autonomic nerve preservation (PANP) with lateral lymph node dissection (LLND) has been introduced in rectal cancer surgery in Japan; however, its indication has not been standardized yet.
  
  
  METHODS
  Forty-four patients with advanced lower rectal cancer were randomized to either the standard treatment group (control group) or the intraoperative radiotherapy (IORT) group. All patients underwent potentially curative resection of the rectum with total mesorectal excision. The control group underwent bilateral LLND and limited PANP. The IORT group underwent bilateral LLND, complete PANP, and IORT. Patients allocated to the IORT group received IORT to the bilateral preserved pelvic nerve plexuses. Patients' clinicopathologic parameters, postoperative complications, voiding function, and prognosis were compared between the two groups.
  
  
  RESULTS
  Among 44 patients enrolled, three patients were excluded from the analysis, resulting in 19 patients in the IORT group and 22 patients in the control group. Patients' demographic and pathological parameters and postoperative complications were well balanced between the two groups. Oncological outcomes including overall and disease-free survival were also similar. Local recurrence was observed in one patient in each group. Among the 34 patients not complicated with intrapelvic abscess, the mean duration of urinary catheter indwelling was 8 days in the IORT group and 13 days in the control group (p = 0.055). In the long term, medication for urination was necessitated in four patients in the control group, whereas in none in the IORT group (p = 0.059).
  
  
  CONCLUSIONS
  Oncological outcomes in the IORT group are equal to those in the control group, and voiding functions in the IORT group are superior to those in the control group. These results suggest that IORT may be useful to expand the indication of complete PANP with LLND for advanced lower rectal cancer.
authors.affiliation: Department of Surgery, Kyorin University, Tokyo, Japan. masaki@kyorin-u.ac.jp
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Masaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Takayama
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.forename: Hisayo
authors.initials: H
authors.lastname: Ueki
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Ayako
authors.initials: A
authors.lastname: Tonari
authors.forename: Junko
authors.initials: J
authors.lastname: Kusuda
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Mizumoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Atomi
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000528:radiation effects / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007564:Japan; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D010388:Pelvis / Q000294:innervation*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012007:Rectum / Q000294:innervation*; D012307:Risk Factors; D014546:Urinary Catheterization; D014555:Urination Disorders / Q000209:etiology