Abstract
When total mesorectal excision (TME) is accurately performed, dysfunction, theoretically, does not occur. However, there are differences among individuals in the running patterns and the volumes of nerve fibers, and if obesity or a narrow pelvis is present, nerve identification is difficult. Currently, the rate of urinary dysfunction after rectal surgery ranges from 33% to 70%. Many factors other than nerve preservation play a role in minor incontinence. Male sexual function shows impotence rates ranging from 20% to 46%, while 20%–60% of potent patients are unable to ejaculate. In women, information on sexual function is not easily obtained, and there are more unknown aspects than in men. As urinary, sexual, and defecation dysfunction due to adjuvant radiotherapy have been reported to occur at a high frequency, the creation of a protocol that enables analysis of long-term functional outcome will be essential for future clinical trials. In the treatment of rectal cancer, surgeon-related factors are extremely important, not only in achieving local control but also in preserving function. This article reviews findings from recent studies investigating urinary, sexual, and defecation dysfunction after rectal cancer surgery and discusses questions to be studied in the future.
Similar content being viewed by others
References
LL Gunderson H Sosin (1974) ArticleTitleArea of failure found at reoperation following ‘curative surgery’ for adenocarcinoma of the rectum Cancer 34 1278–1292 Occurrence Handle4424091 Occurrence Handle1:STN:280:CSqD3s3nsVc%3D Occurrence Handle10.1002/1097-0142(197410)34:4<1278::AID-CNCR2820340440>3.0.CO;2-F
SJ Pilipsen M Heilweil SH Quan et al. (1984) ArticleTitlePatterns of pelvic recurrence following definitive resection of rectal cancer Cancer 53 1354–1362 Occurrence Handle10.1002/1097-0142(19840315)53:6<1354::AID-CNCR2820530623>3.0.CO;2-J
RJ Heald EM Husband DH Ryall (1982) ArticleTitleThe mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg 69 613–616 Occurrence Handle6751457 Occurrence Handle1:STN:280:BiyD38zpsVU%3D
JK MacFarlane RD Ryll RJ Heald (1993) ArticleTitleMesorectal excision for rectal cancer Lancet 341 457–460 Occurrence Handle8094488 Occurrence Handle1:STN:280:ByyC28vnslc%3D Occurrence Handle10.1016/0140-6736(93)90207-W
(1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 336:980–987
E Kapiteijn CA Marijnen ID Nagtegaal et al. (2001) ArticleTitlePreoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–646 Occurrence Handle11547717 Occurrence Handle1:STN:280:DC%2BD3Mvps1ektw%3D%3D Occurrence Handle10.1056/NEJMoa010580
Y Moriya K Hojo T Sawada et al. (1989) ArticleTitleSignificance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection Dis Colon Rectum 32 307–315 Occurrence Handle2784376 Occurrence Handle1:STN:280:BiaC2s%2FgsFM%3D
WH Steup Y Moriya van de Velde (2002) ArticleTitlePatterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases Eur J Cancer 38 911–918 Occurrence Handle11978516 Occurrence Handle1:STN:280:DC%2BD383ktVyrug%3D%3D Occurrence Handle10.1016/S0959-8049(02)00046-1
JH Scholefield WH Steup (1992) ArticleTitleSurgery for rectal cancer in Japan Lancet 340 1101 Occurrence Handle1357491 Occurrence Handle1:STN:280:ByyD38zktFE%3D Occurrence Handle10.1016/0140-6736(92)93124-6
N Matuoka Y Moriya T Akasu et al. (2001) ArticleTitleLong-term outcome of urinary function after extended lymphadenectomy in patients with distal rectal cancer Eur J Surg Oncol 27 165–169 Occurrence Handle10.1053/ejso.2000.1064
Y Moriya K Sugihara T Akasu et al. (1995) ArticleTitleNerve-sparing surgery with lateral node dissection for advanced lower rectal cancer Eur J Cancer 31A 1229–1232 Occurrence Handle7577028 Occurrence Handle1:STN:280:BymD2cnjtlE%3D Occurrence Handle10.1016/0959-8049(95)00164-E
T Mori K Takahashi M Yasuno (1998) ArticleTitleRadical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection Langenbecks Arch Surg 383 409–415 Occurrence Handle9921940 Occurrence Handle1:STN:280:DyaK1M7hvV2isQ%3D%3D Occurrence Handle10.1007/s004230050153
T Takahashi M Ueno K Azekura et al. (2000) ArticleTitleLateral node dissection and total mesorectal excision for rectal cancer Dis Colon Rectum 43 IssueID10 Suppl S59–68 Occurrence Handle11052480 Occurrence Handle1:STN:280:DC%2BD3crgtl2gsg%3D%3D Occurrence Handle10.1007/BF02237228
K Sato T Sato (1991) ArticleTitleThe vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia Surg Radiol Anat 13 17–22 Occurrence Handle2053040 Occurrence Handle1:STN:280:By6B2s3ht1w%3D Occurrence Handle10.1007/BF01623135
L Leveckis NR Boucher BT Parys et al. (1995) ArticleTitleBladder and erectile dysfunction before and after surgery for rectal cancer Br J Urol 76 752–756 Occurrence Handle8535720 Occurrence Handle1:STN:280:BymC3sfgsFc%3D
JW Fowler DN Brenner LEF Moffat et al. (1978) ArticleTitleThe incidence and consequence of damage to the parasympathetic nerve supply to the bladder after abdominoperineal resection of the rectum for carcinoma Br J Urol 50 95–98 Occurrence Handle754858 Occurrence Handle1:STN:280:Bi%2BD3c7gvFA%3D Occurrence Handle10.1111/j.1464-410X.1978.tb03033.x
CP Maas Y Moriya WH Steup et al. (2000) ArticleTitleA prospective study on radical and nerve-preserving surgery for rectal cancer in the Netherlands Eur J Surg Oncol 26 751–757 Occurrence Handle11087640 Occurrence Handle1:STN:280:DC%2BD3M7jvFKntA%3D%3D Occurrence Handle10.1053/ejso.2000.0998
K Havenga WE Enker K McDermott et al. (1996) ArticleTitleMale and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum J Am Coll Surg 182 495–502 Occurrence Handle8646349 Occurrence Handle1:STN:280:BymB2c3ht1w%3D
IR Daniel S Woodward FGM Taylor et al. (2006) ArticleTitleFemale urogenital dysfunction following total mesorectal excision for rectal cancer World J Surg Oncol 4 6–9 Occurrence Handle10.1186/1477-7819-4-6
AK Banerjee (1999) ArticleTitleSexual dysfunction after surgery for rectal cancer Lancet 353 1900–1901 Occurrence Handle10371565 Occurrence Handle1:STN:280:DyaK1M3psl2ktw%3D%3D Occurrence Handle10.1016/S0140-6736(99)00127-0
WE Enker (1992) ArticleTitlePotency, cure, and local control in the operative treatment of rectal cancer Arch Surg 127 1396–1402 Occurrence Handle1365683 Occurrence Handle1:STN:280:ByqC3svgs1w%3D
K Maas Y Moriya G Kenter et al. (1999) ArticleTitleA plea for preservation of the pelvic autonomic nerves Lancet 354 772–773 Occurrence Handle10475214 Occurrence Handle1:STN:280:DyaK1Mvgt1Wquw%3D%3D Occurrence Handle10.1016/S0140-6736(05)76009-8
GA Porter CL Soskoine WW Yakimets et al. (1998) ArticleTitleSurgeon-related factors and outcome in rectal cancer Ann Surg 227 157–167 Occurrence Handle9488510 Occurrence Handle1:STN:280:DyaK1c7kslygtg%3D%3D Occurrence Handle10.1097/00000658-199802000-00001
CJ Beard C Lamb L Buswell et al. (1998) ArticleTitleRadiation-associated morbidity in patients undergoing small-field external beam irradiation for prostate cancer Int J Radiat Oncol Biol Phys 41 257–262 Occurrence Handle9607338 Occurrence Handle1:STN:280:DyaK1c3mvVemtg%3D%3D Occurrence Handle10.1016/S0360-3016(98)00054-6
DJ Little DA Kuban LB Levy et al. (2003) ArticleTitleQuality-of-life questionnaire results 2 and 3 years after radiotherapy for prostate cancer in a randomized dose-escalation study Urology 62 707–713 Occurrence Handle14550448 Occurrence Handle10.1016/S0090-4295(03)00504-1
AG Heriot PP Tekkis VW Fazio et al. (2005) ArticleTitleAdjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer Ann Surg 242 502–511 Occurrence Handle16192810
CAM Marijnen CJH van de Velde H Putter et al. (2005) ArticleTitleImpact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of multicenter randomized trial J Clin Oncol 23 1847–1858 Occurrence Handle15774778 Occurrence Handle10.1200/JCO.2005.05.256
DG Jayne JM Brown H Thorpe et al. (2005) ArticleTitleBladder and sexual function following resection for rectal cancer in randomized clinical trial of laparoscopic versus open technique Br J Surg 92 1124–1132 Occurrence Handle15997446 Occurrence Handle1:STN:280:DC%2BD2MvkvVKlug%3D%3D Occurrence Handle10.1002/bjs.4989
SK Hendren BI O'Connor M Liu et al. (2005) ArticleTitlePrevalence of male and female sexual dysfunction is high following surgery for rectal cancer Ann Surg 242 212–223 Occurrence Handle16041212 Occurrence Handle10.1097/01.sla.0000171299.43954.ce
R Schiessel J Karner-Hanusch F Herbst et al. (1994) ArticleTitleIntersphincteric resection for low rectal tumours Br J Surg 81 1376–1378 Occurrence Handle7953423 Occurrence Handle1:STN:280:ByqD2c7itFw%3D
N Saito M Ono M Sugito et al. (2004) ArticleTitleEarly results of intersphincteric resection for patients with very low rectal cancer. An active approach to avoid permanent colostomy Dis Colon Rectum 47 459–466 Occurrence Handle14978613 Occurrence Handle10.1007/s10350-003-0088-4
H Ueno H Mochizuki Y Hashiguchi et al. (2004) ArticleTitlePreoperative parameters expanding the indication of sphincter preserving surgery in patients with advanced low rectal cancer Ann Surg 239 34–42 Occurrence Handle14685098 Occurrence Handle10.1097/01.sla.0000103070.13030.eb
M Urban HR Rosen N Holbling et al. (2000) ArticleTitleMR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: use of intravenous and endorectal contrast materials Radiology 214 503–508 Occurrence Handle10671600 Occurrence Handle1:STN:280:DC%2BD3c7jvVKlug%3D%3D
B Bittorf U Stadelmaier J Gohl et al. (2004) ArticleTitleFunctional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer Eur J Surg Oncol 30 260–265 Occurrence Handle15028306 Occurrence Handle1:STN:280:DC%2BD2c7jsFOitA%3D%3D Occurrence Handle10.1016/j.ejso.2003.11.011
M Dahlberg B Glimelius W Graf et al. (1998) ArticleTitlePreoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study Dis Colon Rectum 41 543–549 Occurrence Handle9593234 Occurrence Handle1:STN:280:DyaK1c3lsVSltA%3D%3D Occurrence Handle10.1007/BF02235256
CAM Marijnen CJH van de Velde H Putter et al. (2005) ArticleTitleImpact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of multicenter randomized trial J Clin Oncol 23 1847–1858 Occurrence Handle15774778 Occurrence Handle10.1200/JCO.2005.05.256
P Gervaz N Rotholtz SD Wexner et al. (2001) ArticleTitleColonic J-pouch function in rectal cancer patients: impact of adjuvant chemoradiotherapy Dis Colon Rectum 44 1667–1675 Occurrence Handle11711740 Occurrence Handle1:STN:280:DC%2BD3MnmsFKgsA%3D%3D Occurrence Handle10.1007/BF02234388
LK Temple J Bacik SG Savatta et al. (2005) ArticleTitleThe development of validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer Dis Colon Rectum 48 1353–1365 Occurrence Handle15868235 Occurrence Handle10.1007/s10350-004-0942-z
S Saha AG Dan AJ Bilchik et al. (2000) ArticleTitleTechnical details of sentinel lymph node mapping in colorectal cancer and its impact on staging Ann Surg Oncol 7 120–124 Occurrence Handle10761790 Occurrence Handle1:STN:280:DC%2BD3c3it1ChtQ%3D%3D Occurrence Handle10.1007/s10434-000-0120-z
S Bertoglio S Sandrucci P Percivale et al. (2004) ArticleTitlePrognostic value of sentinel lymph node biopsy in the pathologic staging of colorectal cancer patients J Surg Oncol 85 166–170 Occurrence Handle14991889 Occurrence Handle10.1002/jso.20030
J Engel J Kerr A Schlesinger-Raab et al. (2003) ArticleTitleQuality of life in rectal cancer patients: a 4-year prospective study Ann Surg 238 203–213 Occurrence Handle12894013 Occurrence Handle10.1097/00000658-200308000-00008
MG Guren MT Eriksen JN Wiig et al. (2005) ArticleTitleQuality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer Eur J Surg Oncol 31 735–742 Occurrence Handle16180267 Occurrence Handle1:STN:280:DC%2BD2MrgsF2isQ%3D%3D Occurrence Handle10.1016/j.ejso.2005.05.004
MA Sprangers CE Schwartz (1999) ArticleTitleThe challenge of response shift for quality-of-life-based clinical oncology research Ann Oncol 10 747–749 Occurrence Handle10470418 Occurrence Handle1:STN:280:DyaK1MzpvFCguw%3D%3D Occurrence Handle10.1023/A:1008305523548
MG Guren JN Wiig S Dueland et al. (2001) ArticleTitleQuality of life in patients with urinary diversion after operation for locally advanced rectal cancer Eur J Surg Oncol 27 645–651 Occurrence Handle11669593 Occurrence Handle1:STN:280:DC%2BD3MrmslWgtg%3D%3D Occurrence Handle10.1053/ejso.2001.1195
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Moriya, Y. Function preservation in rectal cancer surgery. Int J Clin Oncol 11, 339–343 (2006). https://doi.org/10.1007/s10147-006-0608-z
Received:
Issue Date:
DOI: https://doi.org/10.1007/s10147-006-0608-z