Pelvic nerve preservation for preserving sexual function following rectal cancer surgery

Sexual dysfunction is a serious problem to male patients after surgical treatment of rectal carcinoma. Pelvic autonomic nerve preserving procedure for rectal cancer has been performed to maintain male sexual function, the function was outlined through clinical interview. Lateral lymph node dissection has been performed in combination to decrease local failure. In a series of 46 male patients who underwent autonomic nerve preserving operation and lateral lymph node dissection for rectal cancer, preoperative and postoperative sexual function were obtained by questionnaire. Patients receiving low anterior resection (LAR) were classified as Group I and high anterior resection (HAR) as Group II. All patients received regular follow-up with digital and physical examination and CEA level every three months, and liver echo, CXR and colonoscope every year. Of all our patients who had complete preservation of the autonomic nerve, 92.3% in Group I and 100% in Group II maintained erectile potency. 81% in Group I and 90% in Group II of patients, ejaculatory potencies were maintained. There were 3 patients in either group, accounting 11.4% in Group I and 15% in Group II, who were reported as partial impotence. During the median follow-up-of 29 months, one local recurrence with distant metastasis (4%) was observed in Group I. Other two distant metastasis were noted, 1 in Group I and 1 in Group II. To maintain satisfactory sexual function, complete autonomic nerve preserving operation is necessary. In combination with lateral lymph node dissection, incidence of local recurrence rate could be reduced.