Lateral pelvic lymphadenectomy and total nerve sparing for locally advanced rectal cancer in Western patients.

In an attempt to improve the results of locally advanced rectal cancer treatment, we performed an extended surgical technique consisting of total mesorectal excision (TME), lateral pelvic lymphadenectomy (LPL) and total nerve sparing (NS). Resection of the autonomic nerves was realized only when these fibres were involved by the tumour.Nine cases (9.2%) of a personal series of 98 western patients with rectal carcinoma operated on between January 1992 and December 1997 at Third Department of Surgery, University La Sapienza, Rome, underwent TME, LPL and NS procedures for locally advanced extraperitoneal disease.Two out of seven patients in stage II/III suffered postoperatively from urinary retention with mild irregular flow as tested on urodynamics, but no long-term urinary disturbances persisted. Retrograde ejaculation occurred postoperatively in one of two patients who experienced urinary disturbances. Another patient had erection dysfunctions. These sexual dysfunctions did not improve during the long-term follow-up. Seven patients with stage II or stage III disease achieved a 5-year survival rate of 80.0% and a 5-year disease-free survival rate of 68.6% after a mean follow-up period of 64.7 months. None of them experienced local recurrence, but one patient died of diffuse metastatic disease 50 months after surgery. Two patients with stage IV rectal carcinoma died of local and distant disease 13 months and 35 months after operation. One patient underwent liver resection for solitary metastasis 25 months after primary operation.TME, LPL, and NS with resection of autonomic nerves only when these fibres are involved by the disease can achieve satisfactory results in terms of survival and functional outcome in selected western patients with locally advanced rectal cancer.