Rationale of pelvic autonomic nerve preservation in rectal cancer surgery based on immunohistochemical study

Abstract

Cancer cell involvement was not seen in and around the pelvic autonomic nerves, suggesting that complete pelvic autonomic nerve preservation may be feasible, unless nerves are invaded by the tumor. In some cases, however, metastatic nodes were seen very close to the nerves. Meticulous lymph node dissection along the pelvic autonomic nerves is mandatory.

Management of internal iliac and obturator lymph nodes in mid-low rectal cancer

“…Findings from the JCOG0212 study indicate that preserving autonomous nerves during LLND does not increase the incidence of postoperative urinary dysfunction compared to conventional TME [ 46 ]. Immunohistochemical studies of resected specimens reveal that the pelvic autonomous nerve plane lacks lymph node tissue, providing theoretical support for nerve preservation [ 47 ]. Performing LLND for rectal cancer guided by fascial planes, rather than a vessel-oriented approach, better safeguards the pelvic autonomous nerves and reduces the risk of postoperative urinary and male reproductive dysfunction [ 10 , 48 ].…”