[Efficiency analysis on functional protection of nerve plane-oriented laparoscopic total mesorectal excision]

Area of Science:

• Surgical Oncology
• Urology
• Gastroenterology
• Pelvic Surgery

Background:

• Rectal cancer surgery, particularly total mesorectal excision (TME), poses risks to pelvic autonomic nerves, potentially impacting urinary and sexual functions.
• Previous techniques like pelvic autonomic nerve preservation (PANP+TME) aimed to mitigate these risks, but nerve plane-oriented approaches offer enhanced precision.
• Evaluating novel surgical techniques is crucial for improving patient outcomes and quality of life after rectal cancer treatment.

Purpose of the Study:

• To compare the efficacy of nerve plane-oriented laparoscopic total mesorectal excision (NPO+LTME) versus traditional total mesorectal excision (TME) and pelvic autonomic nerve preservation with total mesorectal excision (PANP+TME) in preserving urinary and sexual function.
• To assess the impact of NPO+LTME on postoperative neurological recovery, specifically focusing on urinary continence, erectile function, and ejaculation.
• To determine if NPO+LTME offers superior functional outcomes compared to existing surgical modalities for rectal cancer.

Main Methods:

• A retrospective cohort study involving 173 male patients with middle and low rectal adenocarcinoma (T1-2) who underwent laparoscopic surgery.
• Patients were divided into three groups: TME (n=58), PANP+TME (n=63), and NPO+LTME (n=52).
• Key outcomes including operation time, blood loss, urinary catheter removal time, urinary function, and sexual function (erection and ejaculation) were compared at 3 and 6 months post-surgery.

Main Results:

• The NPO+LTME group demonstrated significantly better urinary function recovery (84.1% Grade I) compared to PANP+TME (39.7%) and TME (19.2%).
• Erectile function recovery was highest in the NPO+LTME group (85.7% at 6 months), followed by PANP+TME (53.4%) and TME (48.1%).
• Ejaculation function recovery also favored NPO+LTME (87.3% at 6 months) over PANP+TME (60.3%) and TME (46.1%), with no severe disorders in the NPO+LTME group.

Conclusions:

• Nerve plane-oriented laparoscopic total mesorectal excision (NPO+LTME) is superior in preserving postoperative neurological function, leading to better recovery of urinary and sexual functions.
• The NPO+LTME technique facilitates improved patient quality of life by minimizing the impact of rectal cancer surgery on vital functions.
• This approach represents a significant advancement in laparoscopic rectal cancer surgery, emphasizing precise nerve preservation.