title: Functional long-term results after rectal cancer surgery--technique of the athermal mesorectal excision.
abstract: OBJECTIVE
  The total mesorectal excision (TME), embedded in a multimodal therapeutic concept, is accepted as the standard therapy of the advanced adenocarcinoma of the middle and lower thirds. The thermal damages of the autonomous nerves in the little pelvis caused by dissection devices remains a large problem. For our patients, we use water-jet dissection (WJD)-aided TME with the intention to minimise the rate of bladder and sexual function disorders.
  
  
  METHODS
  From October 2001 until June 2010, we recorded 125 patients with an adenocarcinoma of the middle and lower third of the rectum. Ninety deep anterior rectum resections and 35 abdominoperineal rectum extirpations by WJD were performed. Of the patients, 27.2 % received neoadjuvant radiochemotherapy. Bladder and sexual function disorders were assessed by International Prostate Symptom Score and International Index of Erectile Function.
  
  
  RESULTS
  The median follow-up period was 46 (2-117) months. Considering a local recurrence rate of 9.6 %, the tumour-specific 5-year survival of the entire collective was 75.4 %. Long-term bladder function disorders showed in 6.0 % (4/64) and sexual function disorders in 25.0 % (9/36) of the male patients in the course of time.
  
  
  CONCLUSIONS
  The specific advantage of the WJD technique is not only the facilitated dissection between the mesorectal fascia and the surrounding nervous structures in the little pelvis but also a completely athermal TME. The rate of bladder and sexual function disorders is an excellent result compared to that of international centres. Due to the size of the patient collective and the retrospective character of the study, further studies are necessary to validate the presented results.
authors.affiliation: Department of General Surgery, Städtisches Klinikum, Lukaskrankenhaus Neuss, Neuss, Germany, ATouloumtzidis@web.de.
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Touloumtzidis
authors.forename: Björn
authors.initials: B
authors.lastname: Sostmann
authors.forename: Nicole
authors.initials: N
authors.lastname: Hilgers
authors.forename: Marc A
authors.initials: MA
authors.lastname: Renter
authors.forename: Petra
authors.initials: P
authors.lastname: Kühn
authors.forename: Peter E
authors.initials: PE
authors.lastname: Goretzki
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Lammers
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017776:Autonomic Pathways / Q000293:injuries; D059186:Chemoradiotherapy, Adjuvant; D004210:Dissection / Q000009:adverse effects* / Q000379:methods*; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010388:Pelvis / Q000294:innervation; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D015996:Survival Rate; D014555:Urination Disorders / Q000209:etiology*