| Objective: Surgical strategy is the main treatment for rectal cancer. And urogenital dysfunction is common complication due to injury to the pelvic autonomic nerve during operation. It has been reported that urinary and sexual function can be protected following D3 Lymphadenectomy with pelvic autonomic nerve preservation (PANP) for advanced rectal cancer. However data regarding urinary function after laparoscopic D3 Lymphadenectomy with PANP have not been reported. The goal of this study was to determine the effects of laparoscopic D3 Lymphadenectomy with PANP on urinary function in male patients with rectal cancer.Methods: Patients with advanced middle and lower rectal cancer registered in this study were divided randomly into laparoscopic group and open group. All patients were treated by D3 Lymphadenectomy and pelvic autonomic nerve preservation. Operation time, blood loss, post operation complications hospital stay and so on was observed during and after operation. Urine flowmetry was performed using an Urodyn flowmeter before surgery and 3 and 6 months after. All patients were asked to complete the standardized International Prostate Symptom Score (IPSS) questionnaire before surgery and 6 months after. Also patients were asked to complete the standardized International Index of Erectile Function (IIEF) questionnaire before surgery and 3, 6, 12months after. In total, this study consisted of 119 males with advanced rectal cancer.Results: There were no significant differences after surgery 3 monthes between LS and OS in maximal flow rate (18.7±4.6ml/s vs. 18.3±5.2ml/s, p=1.37), voided volume (208.6±54.3ml vs. 212.2±61.0ml, p=0.67), residual urine volume (3.2±1.7ml vs. 2.5±2.1ml, p=0.43), maximum detrusor pressure (41.6±6.8cmH2O vs. 42.4±7.9cmH2O, p=0.561), maximal urethral pressure (68.7±9.1 cmH2O vs. 71.0±12.2cmH2O, p=0.983) . And no significant differences was found after surgery 6 monthes between LS and OS in maximal flow rate (19.8±3.9ml/s vs. 18.6±3.0ml/s, p=0.07), voided volume (211.5±77.2ml vs. 209.8±59.8ml, p=0.898), residual urine volume (2.6±1.5ml vs. 2.3±1.9ml, p=0.273), maximum detrusor pressure (43.3±10.2cmH2O vs. 45.6±12.1cmH2O, p=0.124), maximal urethral pressure (70.5±13.6 cmH2O vs. 72.3±15.8cmH2O, p=1.082) and IPSS (p=0.19). The total IPSS score and quality of life score have no significant change between two groups. Sexual dysfunction rate of LS and OS at 3rd month after operation was 33.3% and 32.2% respectively, and 21.6% vs. 27.1% after 6 months, and 15% vs. 16.9% after 12 months. There was no significant difference between LS and OS in sexual dysfunction rate after surgery.Conclusions:1. A magnified view of the pelvis may facilitate autonomic nerve identification and lateral node dissection. It is feasible to perform D3 Lymphadenectomy and PANP by laparoscopic technique.2. Urinary function can be well evaluated by IPSS and urine flowmetry after D3 Lymphadenectomy and PANP.3. No significant differences were seen in maximal urinary flow rate, voided volume, or residual volume before and after surgery. And there were no significant difference in each terms of IPSS before and after surgery. The male urinary function after D3 lampadenectomy and PANP by laparoscopic technique is equal with that of open technique.4. The incidence of male sexual dysfunction after D3 Lymphadenectomy and PANP by laparoscopic technique or open technique is not high, and there is no significant difference between both groups. And this can be attributed to the PANP technique.
|
PDF Full Text Request