Bladder and sexual dysfunction after mesorectal excision for rectal cancer

BACKGROUND: Urinary and sexual dysfunction are recognized complications of rectal excision for cancer. The aim of this study was to examine the frequency of such complications after mesorectal excision, shortly after this method was introduced. METHODS: Spontaneous flowmetry, residual volume of urine measurement and urodynamic examination, including cystometry and simultaneous detrusor pressure and urinary flow recording, was carried out before and 3 months after curative rectal excision. Urinary symptoms and sexual function were evaluated by means of questionnaires before and after operation. Each patient served as his or her own control. RESULTS: Forty-nine consecutive patients, 39 of whom had a total mesorectal excision (TME) and ten a partial mesorectal excision, were examined before surgery and 35 again after operation. In two patients, a weak detrusor was detected before operation. Two patients developed signs of bladder denervation after operation. Transitory moderate urinary incontinence appeared in four other women. Six of 24 men reported some reduction in erectile function and one became impotent. Two men reported retrograde ejaculation. All the complications were seen in the TME group. CONCLUSION: Mesorectal excision for rectal cancer resulted in a low frequency of serious bladder and sexual dysfunction.     

腹腔镜和开腹直肠癌手术对男性性功能的影响

目的 探讨腹腔镜和开腹直肠癌根治术对男性性功能的影响.方法 将2001年5月至2008年11月间行完全腹腔镜下直肠癌根治术的17例65岁以下的男性病人作为研究对象,另选择同期施行开腹手术的21例男性直肠癌病人作为对照组.对两组病例术后性功能情况进行回顾分析.结果 两组之间术前及术后6个月、12个月IIEF-5评分无明显差异,无论腹腔镜组还是开腹组术后IIEF.5评分均较术前有下降,差异有统计学意义(P<0.05).两组与手术有关的射精功能障碍发生率,术后6月时为37.50%和42.11%(P>0.05),术后12月时为37.50%和36.84%(P>0.05),两组比较差异均无统计学意义.结论 腹腔镜直肠癌根治术后性功能障碍的发生率与开腹手术相比没有差异.     

Comparison of laparoscopically assisted and conventional ileocolic resection for Crohn's disease.

OBJECTIVE: To compare safety, outcome, and feasibility of laparoscopic assisted and conventional laparotomy for ileocolic resection in Crohn's disease. DESIGN: Retrospective study. SETTING: Private clinic, USA. SUBJECTS: 74 patients who had ileocolic resection and anastomosis for Crohn's disease between August 1991 and July 1996, 48 through conventional laparotomy and 26 in whom it was laparoscopically assisted. MAIN OUTCOME MEASURES: Age, operating time, duration of hospital stay, early and late morbidity, and patients' subjective assessment. RESULTS: The mean age was 42 (+/- 17) in the conventional group and 40 (+/- 15) in the laparoscopically assisted group. The mean operating time was significantly shorter in the conventional group, 90.5 +/- 3.7 minutes, compared with 150 +/- 1.2 minutes in the laparoscopic-assisted group (p < 0.0001), but they stayed in hospital significantly longer, 9.6 +/- 0.6 days in the conventional group, compared with 7 +/- 0.8 days in the laparoscopic-assisted group (p < 0.0001). There were no differences between the groups in the incidence of early complications or the cost of admission, but at a mean follow up of 30 months (range 2-59) significantly more patients in the conventional group had developed symptomatic bowel obstruction (15/48 compared with 2/26, p = 0.02). 31 patients in the conventional group (65%) and 16 in the laparoscopically assisted group (62%) returned their subjective assessments. There were no differences between the groups in the number with changed bowel habits, use of drugs for bowel movement, or restricted diet, but patients in the laparoscopically assisted group returned to work more quickly (3.7 +/- 1.2 weeks) compared with 8.2 +/- 1.1 weeks in the conventional group, had better cosmetic results (14/16 compared with 13/31, p = 0.004), and were more likely to have improved social and sexual lives (8/16 compared with 5/31, p = 0.02). CONCLUSION: Laparoscopically assisted ileocolic resection for Crohn' s disease is safe and has less morbidity than conventional laparotomy.     

Cost of open versus laparoscopically assisted right hemicolectomy for cancer

n = 28) or ORHC ( n = 33) was performed. The analysis focused on the cost (in Australian dollars) incurred from the date of operation to the date of discharge. LARHC was significantly more expensive than ORHC (total cost LARHC $9064, ORHC $7881; p < 0.001). LARHC was associated with a significantly longer operating room utilization time (LARHC 261 minutes, ORHC 203 minutes; p < 0.001) and a greater cost of disposables (LARHC $854, ORHC $189; p < 0.001). This study demonstrates no cost benefit for LARHC compared to ORHC when performed for cancer.     

Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique

BACKGROUND: Bladder and sexual dysfunction are recognized complications of mesorectal resection. Their incidence following laparoscopic surgery is unknown. METHODS: Bladder and sexual function were assessed in patients who had undergone laparoscopic rectal, open rectal or laparoscopic colonic resection as part of the UK Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial, using the International Prostatic Symptom Score, the International Index of Erectile Function and the Female Sexual Function Index. Sexual and bladder function data from the European Organization for Research and Treatment of Cancer QLQ-CR38 collected in the CLASICC trial were used for comparison. RESULTS: Two hundred and forty-seven (71.2 per cent) of 347 patients completed questionnaires. Bladder function was similar after laparoscopic and open rectal operations for rectal cancer. Overall sexual function and erectile function tended to be worse in men after laparoscopic rectal surgery than after open rectal surgery (overall function: difference - 11.18 (95 per cent confidence interval (c.i.) -22.99 to 0.63), P = 0.063; erectile function: difference -5.84 (95 per cent c.i. -10.94 to -0.74), P = 0.068). Total mesorectal excision (TME) was more commonly performed in the laparoscopic rectal group than in the open rectal group. TME (odds ratio (OR) 6.38, P = 0.054) and conversion to open operation (OR 2.86, P = 0.041) were independent predictors of postoperative male sexual dysfunction. No differences were detected in female sexual function. CONCLUSION: Laparoscopic rectal resection did not adversely affect bladder function, but there was a trend towards worse male sexual function. This may be explained by the higher rate of TME in the laparoscopic rectal resection group.     

Results of laparoscopically assisted colon resection for carcinoma

BACKGROUND: Surgical resection is the primary treatment for colorectal carcinoma. Laparoscopically assisted colon resection technically is feasible for both benign and malignant disease. However, the role of laparoscopically assisted colon resection for carcinoma is controversial. METHODS: We prospectively studied our first 100 patients with colorectal carcinoma who successfully underwent laparoscopically assisted colon resection for the carcinoma. RESULTS: The pathologic stages were Dukes' categories A-16, B-52, C-25, and D-7. Operative mortality and morbidity were 2% and 22%, respectively. During a mean follow-up period of 40.3 months, recurrence by stage was zero patients with stage A disease, five patients with stage B disease, nine patients with stage C disease. Thirteen of these patients died as a result of their disease. At this writing, 60 patients are alive without evidence of disease, and 23 have completed the study disease free after more than 60 months. The 5-year survival probabilities by stage were 100% for stage A, 76.8% for stage B, and 51.7% for stage C. CONCLUSIONS: Laparoscopically assisted colectomy for cancer can be performed safely. The recurrence rate after laparoscopically assisted resection appears to be at least as good as after open resection. Results from ongoing prospective, randomized trials are needed to confirm these findings.     

Bladder dysfunction after low anterior resection for mid-rectal cancer

Twenty consecutive patients with carcinoma 7 to 12 cm from the anus underwent radical low anterior resection of the rectum; the anastomosis was performed by the EEA stapling instrument. One patient died from pulmonary complications. On urologic follow-up 6 to 8 months after the operation, five patients had significant symptoms from the urinary tract, and in three patients denervation of the bladder was demonstrated. The study establishes that bladder paresis, which is a well-known complication after extirpation of the rectum, also may follow very low anterior resection with anastomosis. The importance of careful follow-up is emphasized.     

Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymphadenectomy for advanced gastric cancer

Background  

Laparoscopically assisted gastric surgery has become an option for the treatment of early gastric cancer. However, the feasibility and safety of laparoscopically assisted gastrectomy for advanced gastric cancer has rarely been studied. This study evaluated the short- and long-term outcomes of laparoscopically assisted distal gastrectomy (LADG) for advanced gastric cancer.     

Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management

Background The feasibility and safety of laparoscopically assisted gastrectomy with extended lymphadenectomy for advanced gastric cancer has rarely been studied. This study aimed to investigate the feasibility, safety, and cancer clearance of laparoscopically assisted distal gastrectomy with D2 lymphadenectomy. Methods Of the 44 patients with distal gastric cancer who underwent radical distal gastrectomy from March 2004 to May 2005, 35 were treated with D2/D2⁺ lymphadenectomy. These patients were compared with 58 patients who, during the same period, underwent a conventional open radical distal gastrectomy. Results The mean total number of retrieved lymph nodes (30.11 ± 16.97) and the mean tumor margin were comparable with those in the open group. The mean operative time for laparoscopically assisted distal gastrectomy was significantly longer than for open surgery (282.84 ± 32.81 min vs 223.75 ± 23.25 min). The patients in the laparoscopic surgery group had less blood loss, shorter times of analgesic injection, and a faster recovery. The rates of complications were comparable between two groups. Conclusions Although laparoscopically assisted radical gastrectomy with D2 lymphadenectomy is more time consuming than open surgery, it is a safe, feasible procedure that achieves cancer clearance similar to open surgery and leads to a quick postoperative recovery.     

Multiple small bowel metastasis after laparoscopically assisted abdominoperineal resection

Long-term outcome after laparoscopic surgery for colorectal cancer is still unknown. Trocar-site implantation and local recurrence has raised concerns about this new method. We present a case of a laparoscopically assisted abdominoperineal resection (APR) with small bowel recurrence 19 months after the APR. A review of the literature also is presented.     

Functional outcomes following laparoscopic and open rectal resection for cancer

A best evidence topic was written according to a structured protocol. The question addressed whether laparoscopic approach confers a difference in functional outcome compared to conventional open resectional surgery for rectal cancer. 246 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and key results of these papers are tabulated. Of these five studies, none showed any difference in post-operative urinary function between patients undergoing laparoscopic or open surgery. The two randomised studies reported either a trend or a significant difference in favour of open surgery for sexual outcome in men. Three more recent, case-control studies showed differences in favour of laparoscopic surgery for sexual function in men. We conclude that there is no evidence to suggest that laparoscopic approach makes any difference to post-operative urinary function. The data relating to sexual function in men is contradictory, and as none of the studies available have generated high level evidence and further trials are required to clarify whether laparoscopic approach confers an advantage or disadvantage in terms of sexual function for men post-operatively. In terms of sexual function in women, the available data is far too scarce to satisfactorily determine whether laparoscopy is superior to open surgery.     

腹腔镜下直肠癌全直肠系膜切除手术

目的 探讨腹腔镜下直肠癌全直肠系膜切除(total mesorectal excision，TME)手术的可行性。方法 自2000年3月至2003年11月共行腹腔镜下直肠癌TME手术67例，其中直肠癌前切除术(anterior resection，AR)45例，直肠癌腹会阴联合切除术(abdominal pelineal resection，APR)22例。结果 本组67例患者按TME原则采用腹腔镜完成直肠癌手术，术中出血量10～50ml，手术时间2.5～5．0h，无术中死亡，术后持续胃肠减压时间8～24h，平均术后24～48h开始进食水，术后1～3d下床活动，术后1～5d开始排便。术后住院时间7～10d。术后随访时间3～43个月，2例患者局部复发，2例患者肝转移；术后因局部复发和肝转移各死亡1例，失访3例；有19例术后不足1年的患者，未发现转移及复发。结论 只要有较好的开腹TME手术经验和腹腔镜操作技能，腹腔镜下直肠癌TME手术是可行的。     

Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer

BACKGROUND: Knowledge of prognostic factors following resection of rectal cancer may be used in the selection of patients for adjuvant therapy. This study examined the prognostic impact of the circumferential resection margin on local recurrence, distant metastasis and survival rates. METHODS: A national population-based rectal cancer registry included all 3319 new patients from November 1993 to August 1997. Some 686 patients underwent total mesorectal excision with a known circumferential margin. This shortest radial resection margin was measured in fixed specimens. None of the patients had adjuvant radiotherapy. RESULTS: Following potentially curative resection and after a median follow-up of 29 (range 14--60) months, the overall local recurrence rate was 7 per cent (46 of 686 patients): 22 per cent among patients with a positive resection margin and 5 per cent in those with a negative margin (margin greater than 1 mm). Forty per cent of patients with a positive margin developed distant metastasis, compared with 12 per cent of those with a negative margin. With decreasing circumferential margin there was an exponential increase in the rates of local recurrence, metastasis and death. CONCLUSION: The circumferential margin has a significant and major prognostic impact on the rates of local recurrence, distant metastasis and survival. Information on circumferential margin is important in the selection of patients for postoperative adjuvant therapy.