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Journal of Gastrointestinal Surgery

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01-06-2017 | Original Article

Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring—a Prospective 2-Year Follow-Up Study

Authors: Daniel W. Kauff, Hauke Lang, Werner Kneist

Published in: Journal of Gastrointestinal Surgery | Issue 6/2017

Abstract

Aim

Urogenital dysfunction is a common sequela following total mesorectal excision for rectal cancer. This prospective study analyzed potential risk factors and investigated the impact of pelvic intraoperative neuromonitoring.

Method

Included were 85 patients undergoing total mesorectal excision for rectal cancer, 43 under the control of pelvic intraoperative neuromonitoring. Urogenital function was assessed with validated questionnaires within a 2-year follow-up period. Potential risk factors were identified by multivariate analysis.

Results

Overall, approximately one-third of treated patients suffered from new onset of urinary dysfunction. Initially, half of the sexually active patients were affected by sexual dysfunction; after 2 years, almost three quarters were affected. In the pelvic intraoperative neuromonitoring group, urinary and sexual dysfunction rates including minor and major disturbances were significantly lower (2-year follow-up 20% vs. 51% (p = 0.004) and 56% vs. 90% (p = 0.010)). Throughout the survey, non-performance of pelvic intraoperative neuromonitoring was found to be an independent risk factor. Neoadjuvant chemoradiotherapy was identified as an independent predictor for urogenital dysfunction in the further course one and 2 years after surgery.

Conclusion

Pelvic intraoperative neuromonitoring is associated with significantly lower rates of urinary and sexual dysfunction in the short and long run, whereas neoadjuvant chemoradiotherapy has a negative impact only in the long run.

Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum J Am Coll Surg 1996;182:495–502.PubMed

Lange MM, van deVelde CJ. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol 2011;8:51–57.CrossRefPubMed

Hendren SK, O'Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005;242:212–223.CrossRefPubMedPubMedCentral

Attaallah, W, Ertekin C, Tinay I, Yegen C. High rate of sexual dysfunction following surgery for rectal cancer. Ann Coloproctol 2014;30:210–215.CrossRefPubMedPubMedCentral

Bregendahl S, Emmertsen KJ, Lindegaard JC, Laurberg S. Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis 2015;17:26–37.CrossRefPubMed

Adam JP, Denost Q, Capdepont M, van Geluwe B, Rullier E. Prospective and longitudinal study of urogenital dysfunction after proctectomy for rectal cancer Dis Colon rectum 2016;59:822–830.

Lange MM, Maas CP, Marijnen CA, Wiggers T, Rutten HJ, Kranenbarg EK, 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 2008;95:1020–1028.CrossRefPubMed

Wallner C, Lange MM, Bonsing BA, Maas CP, Wallace CN, Dabhoiwala NF, Rutten HJ, Lamers WH, Deruiter MC, van de Velde CJ; Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial. Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: a study from the Cooperative Clinical Investigators of the Dutch total mesorectal excision trial. J Clin Oncol 2008;26:4466–4472.CrossRefPubMed

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

10.

Marijnen CA, van de Velde CJ, Putter H, van den Brink M, Maas CP, Martijn H, Rutten HJ, Wiggers T, Kranenbarg EK, Leer JW, Stiggelbout AM. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2005; 23: 1847–1858.CrossRefPubMed

11.

Scheer AS, O'Connor AM, Chan BP, Moloo H, Poulin EC, Mamazza J, Auer RC, Boushey RP. The myth of informed consent in rectal cancer surgery: what do patients retain? Dis Colon rectum 2012;55:970–975.

12.

Kauff DW, Koch KP, Somerlik KH, Hoffmann KP, Lang H, Kneist W. Evaluation of two-dimensional intraoperative neuromonitoring for predicting urinary and anorectal function after rectal cancer surgery. Int J Colorectal Dis 2013;28:659–664.CrossRefPubMed

13.

Denis L, Griffiths K, Khoury S. Measuring the symptom and health impact of benign prostatic hyperplasia and its treatment. In: Denis L, Griffiths K, Khoury S, et al, eds. 4th International consultation on benign prostatic hyperplasia. Paris: Health Publication; 1998:265–280.

14.

Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;11:319–326.CrossRefPubMed

15.

Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 1999;54:346–351.CrossRefPubMed

16.

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;31:1–20.CrossRefPubMed

17.

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;26:191–208.CrossRefPubMed

18.

McLachlan SA, Fisher RJ, Zalcberg J, Solomon M, Burmeister B, Goldstein D, Leong T, Ackland SP, McKendrick J, McClure B, Mackay J, Ngan SY. The impact on health-related quality of life in the first 12 months: a randomised comparison of preoperative short-course radiation versus long-course chemoradiation for T3 rectal cancer (Trans-Tasman Radiation Oncology Group Trial 01.04) Eur J Cancer 2016;55:15–26.CrossRefPubMed

19.

Pollack J, Holm T, Cedermark B, Altma, D, Holmström B, Glimelius B, Mellgren A. Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 2006;93:1519–1525.CrossRefPubMed

20.

Kneist W, Junginger T. Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision. Int J Colorectal Dis 2007;22:675–682.CrossRefPubMed

21.

Kneist W, Hanke L, Kauff DW, Lang, H. Surgeons’ assessment of internal anal sphincter nerve supply during TaTME—inbetween expectations and reality Minim Invasive Ther Allied Technol 2016;25:241–246.CrossRefPubMedPubMedCentral

22.

Kauff DW, Wachter N, Bettzieche R, Lang H, Kneist W. Electrophysiology-based quality assurance of nerve-sparing in laparoscopic rectal cancer surgery: Is it worth the effort? Surg Endosc 2016;30:4525–4532.CrossRefPubMed

23.

Kneist W, Kauff DW, Juhre V, Hoffmann KP, Lang H. Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME? Results of a case-control study. Eur J Surg Oncol 2013;39:994–999.CrossRefPubMed

24.

Fang JF, Wei B, Zheng ZH, Chen TF, Huang Y, Huang JL, Lei PR, Wei HB. Effect of intra-operative autonomic nerve stimulation on pelvic nerve preservation during radical laparoscopic proctectomy. Colorectal Dis 2015;17:268–276.CrossRef

25.

Motson RW, Whiteford MH, Hompes R, Albert M, Miles WF; Expert Group. Current status of trans-anal total mesorectal excision (TaTME) following the Second International Consensus Conference Colorectal Dis 2016;18:13–8.CrossRefPubMed

26.

Duran E, Tanriseven M, Ersoz N, Oztas M, Ozerhan IH, Kilbas Z, Demirbas S. Urinary and sexual dysfunction rates and risk factors following rectal cancer surgery Int J Colorectal Dis 2015;30:1547–1555.CrossRefPubMed

Title: Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring—a Prospective 2-Year Follow-Up Study
Authors: Daniel W. Kauff
Hauke Lang
Werner Kneist
Publication date: 01-06-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 6/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3409-y

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Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring—a Prospective 2-Year Follow-Up Study

Abstract

Aim

Method

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aim

Method

Results

Conclusion

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