Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: Expert technical tips for robotic surgery

Kim, Nam Kyu; Kim, Young Wan; Cho, Min Soo

doi:10.1016/j.suronc.2015.06.012

Cited by 71 publications

(49 citation statements)

References 43 publications

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“…Urogenital function is one of the most important aspects of quality of life and rectal cancer may have adverse effects on it[5,9-13]. Although urogenital dysfunction is considered to be multifactorial, intra-operative damage to the pelvic autonomic nerves is the primary cause[14-16].…”

Section: Introductionmentioning

confidence: 99%

“…Although urogenital dysfunction is considered to be multifactorial, intra-operative damage to the pelvic autonomic nerves is the primary cause[14-16]. This is mainly due to the close proximity of the mesorectum to the autonomic nerves, and the difficulty in identifying such small structures such as the autonomic nerves in a narrow operative space such as the pelvis[13,17]. Damage to the sympathetic nerves results in urinary incontinence, ejaculation disorders in men and decreased orgasmic intensity in women[13,18].…”

Section: Introductionmentioning

confidence: 99%

“…This is mainly due to the close proximity of the mesorectum to the autonomic nerves, and the difficulty in identifying such small structures such as the autonomic nerves in a narrow operative space such as the pelvis[13,17]. Damage to the sympathetic nerves results in urinary incontinence, ejaculation disorders in men and decreased orgasmic intensity in women[13,18]. Damage to the parasympathetic nerves leads to a lack of detrusor muscle function and subsequent voiding disorder, as well as erectile problems and lubrication dysfunction in men and women respectively[13,18].…”

Section: Introductionmentioning

confidence: 99%

“…Damage to the sympathetic nerves results in urinary incontinence, ejaculation disorders in men and decreased orgasmic intensity in women[13,18]. Damage to the parasympathetic nerves leads to a lack of detrusor muscle function and subsequent voiding disorder, as well as erectile problems and lubrication dysfunction in men and women respectively[13,18]. These are significant post-operative and life changing events that jeopardise patients quality of life[9].…”

Section: Introductionmentioning

confidence: 99%

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Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Panteleimonitis

Ahmed

Harper

et al. 2016

WJGS

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AIMTo analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery.METHODSA comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors.RESULTSFifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions.CONCLUSIONThere seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Panteleimonitis

Ahmed

Harper

et al. 2016

WJGS

View full text Add to dashboard Cite

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“…In spite of surgical technical evolution and attention to preservation of pelvic nerves, many patients develop severe urinary, sexual and intestinal disturbances following ARR [6][7][8][9] . The group of functional alterations of intestine following ARR is known as low anterior resection syndrome -LARS 10,11 .…”

Section: Introductionmentioning

confidence: 99%

Aspectos fisiopatológicos da síndrome pós-ressecção anterior do reto para o tratamento de câncer retal

Buzatti

Petroianu

2017

Rev. Col. Bras. Cir.

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RESUMO O número de pacientes com distúrbios funcionais intestinais em decorrência das operações para o tratamento do câncer retal tem aumentado durantes as últimas décadas. Alterações anatômicas e funcionais após a retirada do reto provocam aumento da frequência evacuatória, urgência evacuatória, evacuações múltiplas e incontinência para fezes e flatos, caracterizando a síndrome da ressecção anterior baixa ou LARS - "low anterior resection syndrome". Este artigo apresenta uma revisão geral do tema, com ênfase para conceitos atuais e aspectos fisiopatológicos de distúrbios funcionais do intestino após o tratamento cirúrgico do câncer retal. É fundamental que o cirurgião compreenda esses mecanismos, para melhor abordagem dos pacientes e restabelecimento da sua qualidade de vida.

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Effect of autonomic nervous system resection extent on urinary dysfunction in robotic rectal cancer surgery

Arai,

Kagawa,

Shiomi

et al. 2024

Annals of Gastroent Surgery

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AimWe investigated whether autonomic nervous system resection during robotic rectal surgery contributes to urinary dysfunction and to what extent.MethodsThis retrospective cohort study included patients who underwent rectal surgery for primary rectal cancer between December 2011 and April 2021. We identified urinary dysfunction risk factors and examined the effect of autonomic nervous system resection extent on urinary dysfunction occurrence, with urinary dysfunction defined as a residual urine volume of >50 mL. Urinary dysfunction with no improvement over 1 y was defined as permanent urinary dysfunction.ResultsOf 1017 eligible patients, 78 (7.7%) required autonomic nervous system resection. Lateral lymph node dissection was performed in 357 patients (35.1%). Urinary dysfunction was observed in 102 patients (10.0%). We studied 32 (41.0%) of 78 patients who underwent autonomic nervous system resection and 82 (23.0%) of 357 patients who underwent lateral lymph node dissection presented with urinary dysfunction. Multivariate analysis revealed that lateral lymph node dissection and autonomic nervous system resection were significant predictors of urinary dysfunction. The urinary dysfunction incidence was notably higher in patients with autonomic nervous system unilateral total resection of at least one side than in those with bilateral preservation (65.4% vs. 28.8%, p < 0.01), and permanent urinary dysfunction exclusively occurred in these patients.ConclusionIn robotic surgery, autonomic nervous system resection and lateral lymph node dissection were independent risk factors for urinary dysfunction. Furthermore, the extent of autonomic nervous system resection may increase the risk of permanent urinary dysfunction.

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Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: Expert technical tips for robotic surgery

Cited by 71 publications

References 43 publications

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Aspectos fisiopatológicos da síndrome pós-ressecção anterior do reto para o tratamento de câncer retal

Effect of autonomic nervous system resection extent on urinary dysfunction in robotic rectal cancer surgery

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