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. 2008 Jun;15(6):1609-16.
doi: 10.1245/s10434-008-9861-x. Epub 2008 Mar 26.

Laparoscopic pelvic autonomic nerve-preserving surgery for sigmoid colon cancer

Jin-Tung Liang  1 , Hong-Shiee Lai, Po-Huang Lee, King-Jen Chang
Affiliations

Laparoscopic pelvic autonomic nerve-preserving surgery for sigmoid colon cancer

Jin-Tung Liang et al. Ann Surg Oncol. 2008 Jun.

Abstract

Background: To test the feasibility of laparoscopic approach in performing the simultaneous pelvic autonomic nerve preservation during standard anterior resection of sigmoid colon cancer.

Methods: Patients meeting appropriate eligibility criteria were recruited for the present study. The surgical procedures are shown in the video. The genitourinary function was evaluated on the basis of validated questionnaires including International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI).

Results: A total of 112 patients (tumor, node, metastasis system stage I, n = 8; stage II, n = 54; stage III, n = 50; male, n = 58; female, n = 54; age [mean +/- standard deviation], 55.8 +/- 6.4 years) with good baseline genitourinary function were operated on with the intent of total preservation of pelvic autonomic nerves and curative resection of sigmoid colon cancer. The patients were prospectively followed (median time of follow-up, 18 months; range, 6-30 months). In patients with a successful nerve-preserving surgery (96.4%, n = 108), 104 patients completed the evaluation of urinary function. The median duration for indwelling urine Foley catheter was 3.0 days (range, 1.0-7.0 days). The voiding function after removal of the urine Foley catheter was good (IPSS, 0-7) in 98 (94.2%) patients, fair (IPSS, 8-14) in 5 (4.8%), and poor (IPSS, 15-35) in 1 (1.0%). Before and after nerve-preserving surgery, there were no significant changes of IPSS scores (3.20 +/- 1.72 vs. 3.68 +/- 2.82, P = .075, paired t-test) in the present patient series. Forty-four male patients completed the postoperative evaluation of sexual function, and ejaculation was ranked as good in 40 (90.9%), fair (decrease in ejaculatory amounts) in 3 (6.8%), and poor (retrograde ejaculation, failure of ejaculation) in 1 (2.3%), whereas the potency was good (IIEF, 60-75) in 41 (93.2%), fair (IIEF, 44-59) in 2 (4.5%), and poor (IIEF, 5-43) in 1 (2.3%). Moreover, before and after a successful nerve-preserving operation, there were no significant changes of IIEF scores (72.4 +/- 4.6 vs. 70.3 +/- 8.4, P = .082, paired t-test). For female patients (n = 42), the postoperative sexual function was ranked as good (FSFI score, 76-95) in 36 (85.7%), fair (FSFI, 58-75) in 4 (9.5%), and poor (FSFI, 4-57) in 2 (4.8%). Furthermore, there were no significant changes of FSFI scores (89.0 +/- 9.2 vs. 85.4 +/- 16.4, P = .122, paired t-test) before and after successful nerve-preserving surgery.

Conclusions: Under laparoscopy, we can clearly identify and preserve the pelvic autonomic nerves to retain genitourinary function in most patients undergoing oncologic resection of sigmoid colon cancer.

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Figures

Fig. 1
Fig. 1
(A) Surgical anatomy of pelvic anatomic nerves related to the nerve-preserving surgery of sigmoid colon cancer. (B) The inferior mesenteric plexus (yellow arrow) encircles the root of inferior mesenteric artery (IMA). (C) The superior hypogastric plexus overlying the interiliac trigone area. (D) The right hypogastric nerve travels across the presacral areolar tissue and then adheres to the proper rectal fascia.
See this image and copyright information in PMC

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