[Functional preservation in rectal cancer surgery]

Improvement in the cancer eradication and prevention of pelvic organ dysfunction are the most important strategy in rectal cancer surgery. More than 90% of rectal cancer in my experiences received APR resection before 1962. However, after 1963 anal function preserving operations were adopted 45% or more of rectal cancer. Pull-through was adopted at the beginning, however, anterior resection took the place of this procedure after 1969. When the suture instruments were applied to rectal surgery in 1984, 65% of patients were treated by instrumental end-to end reconstruction. Cancers, which have depth invasion a1, are treated enough with 2 cm length of distal stump, while cancers further depth invasion need 3 cm or more distal stump. Dysuria and male sexual impotence are caused by intrapelvic nerve injuries during surgery. Dysuria was found in 49% and impotence in 38% following conventional surgery. The incidence of dysuria and impotence, however, increased to 67% and 97% by extended dissection, respectively. To prevent these deteriorations, the pelvic node dissection should be limited to do for the locally advanced cases. Nerve preserving operation was performed for cancer with flat sm and slight invasion into pm layer, and the incidence of dysuria and impotence was decreased to 15% and 21%, respectively.