Laparoscopic pelvic autonomic nerve-preserving surgery for sigmoid colon cancer.
BACKGROUND
To test the feasibility of laparoscopic approach in performing the simultaneous pelvic autonomic nerve preservation during standard anterior resection of sigmoid colon cancer.


METHODS
Patients meeting appropriate eligibility criteria were recruited for the present study. The surgical procedures are shown in the video. The genitourinary function was evaluated on the basis of validated questionnaires including International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI).


RESULTS
A total of 112 patients (tumor, node, metastasis system stage I, n = 8; stage II, n = 54; stage III, n = 50; male, n = 58; female, n = 54; age [mean +/- standard deviation], 55.8 +/- 6.4 years) with good baseline genitourinary function were operated on with the intent of total preservation of pelvic autonomic nerves and curative resection of sigmoid colon cancer. The patients were prospectively followed (median time of follow-up, 18 months; range, 6-30 months). In patients with a successful nerve-preserving surgery (96.4%, n = 108), 104 patients completed the evaluation of urinary function. The median duration for indwelling urine Foley catheter was 3.0 days (range, 1.0-7.0 days). The voiding function after removal of the urine Foley catheter was good (IPSS, 0-7) in 98 (94.2%) patients, fair (IPSS, 8-14) in 5 (4.8%), and poor (IPSS, 15-35) in 1 (1.0%). Before and after nerve-preserving surgery, there were no significant changes of IPSS scores (3.20 +/- 1.72 vs. 3.68 +/- 2.82, P = .075, paired t-test) in the present patient series. Forty-four male patients completed the postoperative evaluation of sexual function, and ejaculation was ranked as good in 40 (90.9%), fair (decrease in ejaculatory amounts) in 3 (6.8%), and poor (retrograde ejaculation, failure of ejaculation) in 1 (2.3%), whereas the potency was good (IIEF, 60-75) in 41 (93.2%), fair (IIEF, 44-59) in 2 (4.5%), and poor (IIEF, 5-43) in 1 (2.3%). Moreover, before and after a successful nerve-preserving operation, there were no significant changes of IIEF scores (72.4 +/- 4.6 vs. 70.3 +/- 8.4, P = .082, paired t-test). For female patients (n = 42), the postoperative sexual function was ranked as good (FSFI score, 76-95) in 36 (85.7%), fair (FSFI, 58-75) in 4 (9.5%), and poor (FSFI, 4-57) in 2 (4.8%). Furthermore, there were no significant changes of FSFI scores (89.0 +/- 9.2 vs. 85.4 +/- 16.4, P = .122, paired t-test) before and after successful nerve-preserving surgery.


CONCLUSIONS
Under laparoscopy, we can clearly identify and preserve the pelvic autonomic nerves to retain genitourinary function in most patients undergoing oncologic resection of sigmoid colon cancer.
Liang
Jin-Tung
JT
Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, No. 7 Chung-Shan South Road, Taipei, Taiwan. jintung@ntu.edu.tw
Lai
Hong-Shiee
HS
Lee
Po-Huang
PH
Chang
King-Jen
KJ
D000230:Adenocarcinoma / Q000601:surgery*; D017776:Autonomic Pathways / Q000601:surgery*; D003082:Colectomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000294:innervation; D012735:Sexual Dysfunction, Physiological / Q000517:prevention & control; D012811:Sigmoid Neoplasms / Q000601:surgery*; D020196:Trauma, Nervous System / Q000517:prevention & control*; D014555:Urination Disorders / Q000517:prevention & control