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01-07-2015

A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer

Authors: Andrea Costanzi, Luca Rigamonti, Giulio Maria Mari, Angelo Miranda, Jacopo Crippa, Valter Berardi, Dario Maggioni

Published in: Surgical Endoscopy | Issue 7/2015

Abstract

Introduction

Genito-urinary disorders (GUD) for radical rectal cancer surgery range from 10 to 30 %. In this study, primary endpoint is to prospectively assess their incidence in patients undergoing Laparoscopic Total Mesorectal Excision (LTME) without neoadjuvant chemo-radiation (NCR). Secondary endpoint is to detect the potential lesion site evaluating video-recordings of surgery.

Patients and methods

A study of 35 consecutive patients treated by LTME for extra-peritoneal rectal cancer not subjected to NCR, M:F = 23:12, median age 70, was evaluated preoperatively by Uroflowmetry and US postvoid residual urine measurement (PVR), International Prostatic Symptoms Score (IPSS), and International Consultation on Incontinence Modular Questionnaire (ICIQ) at 1 and 9 months post-operatively. Evaluation of sexual function was carried out by International Index of Erectile Function (IIEF) in males. Data were analyzed performing Fisher and paired samples t tests. Surgical videos of patients affected by GUD were reviewed to identify lesion sites.

Results

Urinary function:IPSS average score: baseline 6.03 ± 5.51, 8.93 ± 6.42 (p = .005) at 1 month, and 7.26 ± 5.55 (p = .041) at 9 months. ICIQ baseline 2.67 ± 5.42, 4.27 ± 6.19 (p = NS) at 1 month, and 3.63 ± 5.23 (p = NS) at 9 months. Maximum urine flow rate baseline 15.95 ± 4.78 ml/s, 14.23 ± 5.27 after 1 month (p = .041), and 15.22 ± 4.01 after 9 months (p = NS). Mean urine flow rate baseline 9.15 ± 2.96 ml/s, 7.99 ± 4.12 ml/s at 1 month (p = .044), and 8.54 ± 4.19 ml/s at 9 months (p = NS). PVR baseline 59.62 ± 54.49, 64.59 ± 58.71 (p = NS) at 1 month, and 68.82 ± 77.72 (p = NS) at 9 months. Sexual function: IIEF baseline 19.38 ± 6.25, 14.06 ± 8.65 at 1 month (p = .011), and 15.4 ± 8.41 at 9 months, (p = NS). Video review of patients with disorders showed potential damage at the site of ligation of IMA (high hypogastric plexus) in 1 case, lateral and posterior mesorectum dissection (hypogastric nerves) in 2 cases, anterior dissection of the Denonvilliers fascia from seminal vesicles in 2 cases.

Conclusions

GUD at 1 month from LTME for rectal cancer are significant but improve at 9 months. Surgical video review of patients with GUD provides an important tool for detection of lesion sites.

Krane MK, Fichera A (2012) Laparoscopic rectal cancer surgery: where do we stand? World J Gastroenterol 18(46):6747–6755 10.3748/wjg.v18.i46.6747. Review. PubMed PMID: 23239912; PubMed Central PMCID: PMC3520163PubMedCentralPubMedCrossRef

Chand M, Heald RJ (2011) Laparoscopic rectal cancer surgery. Br J Surg 98(2):166–167. doi:10.1002/bjs.7379 PubMedCrossRef

Cecil TD, Sexton R, Moran BJ, Heald RJ (2004) Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum 47(7):1145–1149 discussion 1149-50PubMedCrossRef

Heald RJ, Moran BJ, Brown G, Daniels IR (2004) Optimal total mesorectal excision for rectal cancer is by dissection in front of Denonvilliers’ fascia. Br J Surg 91(1):121–123PubMedCrossRef

Mortenson MM, Khatri VP, Bennett JJ, Petrelli NJ. Total mesorectal excision and pelvic node dissection for rectal cancer: an appraisal. Surg Oncol Clin N Am. 2007 Jan;16(1):177-97. Review. PubMed PMID: 17336243

MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341(8843):457–460PubMedCrossRef

Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85(4):526–529PubMedCrossRef

Breukink SO, van der Zaag-Loonen HJ, Bouma EM, Pierie JP, Hoff C, Wiggers T, Meijerink WJ (2007) Prospective evaluation of quality of life and sexual functioning after laparoscopic total mesorectal excision. Dis Colon Rectum 50(2):147–155PubMedCrossRef

How P, Stelzner S, Branagan G, Bundy K, Chandrakumaran K, Heald RJ, Moran B (2012) Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer. Dis Colon Rectum 55(4):400–406PubMedCrossRef

10.

O’Leary DP, Fide CJ, Foy C, Lucarotti ME (2001) Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg 88(9):1216–1220PubMedCrossRef

11.

Bertrand MM, Alsaid B, Droupy S, Benoit G, Prudhomme M (2013) Optimal plane for nerve sparing total mesorectal excision, immunohistological study and 3D reconstruction: an embryological study. Colorectal Dis 15(12):1521–1528PubMedCrossRef

12.

Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg. 2000 87(10):1288–99. Review. PubMed PMID: 11044153

13.

Kauff DW, Kempski O, Huppert S, Koch KP, Hoffmann KP, Lang H, Kneist W (2012) Total mesorectal excision–does the choice of dissection technique have an impact on pelvic autonomic nerve preservation? J Gastrointest Surg. 16(6):1218–1224PubMedCrossRef

14.

Kneist W, Junginger T (2007) Male urogenital function after confirmed nerve-sparing total mesorectal excision with dissection in front of Denonvilliers’ fascia. World J Surg 31(6):1321–1328PubMedCrossRef

15.

Kneist W, Junginger T (2007) Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision. Int J Colorectal Dis 22(6):675–682 Epub 2006 Oct 12PubMedCrossRef

16.

Kim NK, Aahn TW, Park JK, Lee KY, Lee WH, Sohn SK, Min JS (2002) Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum 45(9):1178–1185PubMedCrossRef

17.

Morino M, Parini U, Allaix ME, Monasterolo G (2009) Brachet Contul R, Garrone C. Male sexual and urinary function after laparoscopic total mesorectal excision. Surg Endosc 23(6):1233–1240PubMedCrossRef

18.

Asoglu O, Matlim T, Karanlik H, Atar M, Muslumanoglu M, Kapran Y, Igci A, Ozmen V, Kecer M, Parlak M (2009) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 23(2):296–303PubMedCrossRef

19.

Ho VP, Lee Y, Stein SL, Temple LK (2011) Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum 54(1):113–125PubMedCrossRef

20.

Tekkis PP, Cornish JA, Remzi FH, Tilney HS, Strong SA, Church JM, Lavery IC, Fazio VW (2009) Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum 52(1):46–54PubMedCrossRef

21.

Lange MM, Maas CP, Marijnen CA, Wiggers T, Rutten HJ, Kranenbarg EK (2008) van de Velde CJ; Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 95(8):1020–1028PubMedCrossRef

22.

Clausen N, Wolloscheck T, Konerding MA (2008) How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae. World J Surg 32(8):1768–1775PubMedCrossRef

23.

Eveno C, Lamblin A, Mariette C, Pocard M (2010) Sexual and urinary dysfunction after proctectomy for rectal cancer. J Visc Surg. 147(1):e21–e30PubMedCrossRef

24.

Hida K, Hasegawa S, Kataoka Y, Nagayama S, Yoshimura K, Nomura A, Kawada K, Kawamura J, Kinjo Y, Sakai Y (2013) Male sexual function after laparoscopic total mesorectal excision. Colorectal Dis 15(2):244–251PubMedCrossRef

25.

Moszkowicz D, Alsaid B, Bessede T, Penna C, Nordlinger B, Benoît G, Peschaud F (2011) Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis 13(12):1326–1334PubMedCrossRef

26.

Lepor H. Evaluating men with benign prostatic hyperplasia. Rev Urol. 2004;6 Suppl 1:S8-S15. PubMed PMID: 16985855; PubMed Central PMCID: PMC1472850

27.

Timmermans L, Falez F, Mélot C, Wespes E (2013) Validation of use of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) for impairment rating: A transversal retrospective study of 120 patients. Neurourol Urodyn 32(7):974–979PubMedCrossRef

28.

Klovning A, Avery K, Sandvik H, Hunskaar S (2009) Comparison of two questionnaires for assessing the severity of urinary incontinence: The ICIQ-UI SF versus the incontinence severity index. Neurourol Urodyn 28(5):411–415PubMedCrossRef

29.

Development and evaluation o fan bridge, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfuntion

30.

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 49(6):822–830PubMedCrossRef

31.

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000 26(2):191–208. PubMed PMID: 10782451

32.

Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005 31(1):1–20. PubMed PMID: 15841702

33.

Bray A, Griffiths C, Drinnan M, Pickard R (2012) Methods and value of home uroflowmetry in the assessment of men with lower urinary tract symptoms: a literature review. Neurourol Urodyn 31(1):7–12PubMedCrossRef

34.

Jeon S, Yoo EH (2012) Predictive value of obstructive voiding symptoms and objective bladder emptying tests for urinary retention. J Obstet Gynaecol 32(8):770–772PubMedCrossRef

35.

van Venrooij GE, Boon TA, de Gier RP (1995) International prostate symptom score and quality of life assessment versus urodynamic parameters in men with benign prostatic hyperplasia symptoms. J Urol 153(5):1516–1519PubMedCrossRef

36.

Kelly CE. Evaluation of voiding dysfunction and measurement of bladder volume. Rev Urol. 2004;6 Suppl 1:S32-7. PubMed PMID: 16985853; PubMed Central PMCID: PMC1472847

37.

Oelke M, Höfner K, Jonas U, de la Rosette JJ, Ubbink DT, Wijkstra H (2007) Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol 52(3):827–834 Epub 2006 Dec 22PubMedCrossRef

38.

Zhang C, Ding ZH, Li GX, Yu J, Wang YN, Hu YF (2010) Perirectal fascia and spaces: annular distribution pattern around the mesorectum. Dis Colon Rectum 53(9):1315–1322PubMedCrossRef

39.

Guillem JG, Lee-Kong SA. Autonomic nerve preservation during rectal cancer resection. J Gastrointest Surg. 2010 Feb;14(2):416-22. doi: 10.1007/s11605-009-0941-4. Epub 2009 Jun 23. PubMed PMID: 19548040

40.

Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc. 2011 Sep;25(9):2972-9. doi: 10.1007/s00464-011-1655-8. Epub 2011 Apr 22. PubMed PMID: 21512883

41.

Enker WE. Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg. 1992 127(12):1396–401; discussion 1402. Review. PubMed PMID: 1365683

42.

Maas CP, Moriya Y, Steup WH, Kiebert GM, Kranenbarg WM, van de Velde CJ (1998) Radical and nerve-preserving surgery for rectal cancer in The Netherlands: a prospective study on morbidity and functional outcome. Br J Surg 85(1):92–97PubMedCrossRef

43.

Dagtekin A, Comelekoglu U, Bagdatoglu O, Yilmaz N, Dagtekin O, Koseoglu A, Vayisoglu Y, Karatas D, Korkutan S, Avci E, Bagdatoglu C, Talas D (2011) Comparison of the effects of different electrocautery applications to peripheral nerves: an experimental study. Acta Neurochir (Wien) 153(10):2031–2039CrossRef

44.

Moradzadeh A, Brenner MJ, Whitlock EL, Tong AY, Luciano JP, Hunter DA, Myckatyn TM, Mackinnon SE (2010) Bipolar electrocautery A rodent model of Sunderland third-degree nerve injury. Arch Facial Plast Surg. 12(1):40–47PubMedCrossRef

45.

Carlander J, Johansson K, Lindström S, Velin AK, Jiang CH, Nordborg C (2005) Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery. Br J Surg 92(6):772–777PubMedCrossRef

Title: A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer
Authors: Andrea Costanzi
Luca Rigamonti
Giulio Maria Mari
Angelo Miranda
Jacopo Crippa
Valter Berardi
Dario Maggioni
Publication date: 01-07-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3876-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer

Abstract

Introduction

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusions

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