title: Regeneration and functional recovery of intrapelvic nerves removed during extensive surgery by a new artificial nerve conduit: a breakthrough to radical operation for locally advanced and recurrent rectal cancers.
abstract: OBJECTIVE
  In the current strategy against locally advanced and recurrent rectal cancers possibly involving intrapelvic nerves, there has been a serious dilemma between extensive surgery and limited surgery. The former can attain high tumor curability by sacrificing the nerve functions while the latter prioritizes the patient quality of life by preserving the nerve functions but with a compromised curability. Here we present a new surgical strategy for locally advanced and recurrent rectal cancers, which realize both high tumor curability and good quality of life.
  
  
  METHODS
  A new artificial nerve conduit (polyglycolic acid collagen tube) developed by in site tissue engineering technology was applied to recovery the disturbed functions after removing the nerves from 11 patients undergoing extensive surgery for intrapelvic advanced or recurrent colorectal cancers. The reconstructed nerves included eight autonomic nerves which are essential for the genitourinary function and three somatic nerves which control the sensation and mobility of the legs.
  
  
  RESULTS
  Out of ten cases followed up more than 2 years and evaluated fully, eight including two report cases showed a functional recovery of the disturbed autonomic and somatic nerves clinically. The nerve function started to recover from 3 to 6 months after the operation and continued to improve with times. No specific complications associated with the nerve repair have been noted.
  
  
  CONCLUSIONS
  The new strategy utilizing the nerve conduit can be a breakthrough in radical operations for locally advanced and recurrent rectal cancers to resolve the problems between tumor curability and the patient quality of life.
authors.affiliation: Division of Medical Life System, Department of Life and Medical Science, Doshisha University, 1-3 Tatara-Miyakodani, Kyotanabe, Kyoto, 610-0321, Japan. htsujimobb@yahoo.co.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsujimoto
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Nakamura
authors.forename: Tsuneharu
authors.initials: T
authors.lastname: Miki
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kubo
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Yamagishi
authors.forename: Akeo
authors.initials: A
authors.lastname: Hagiwara
mesh_terms: D000328:Adult; D000368:Aged; D003094:Collagen; D005260:Female; D005267:Femoral Nerve / Q000293:injuries / Q000502:physiology; D048091:Guided Tissue Regeneration / Q000379:methods*; D006801:Humans; D007001:Hypogastric Plexus / Q000293:injuries / Q000502:physiology; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000502:physiology; D009416:Nerve Regeneration / Q000502:physiology*; D009776:Obturator Nerve / Q000293:injuries / Q000502:physiology; D011100:Polyglycolic Acid; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000534:rehabilitation; D014555:Urination Disorders / Q000534:rehabilitation
chemical_list: D011100:Polyglycolic Acid; D003094:Collagen