[Lymphadenectomy and nerve sparing technique in radical surgery of rectal cancer]

The extension that should be given to lateral lymphadenectomy in the surgical treatment of extraperitoneal rectal cancer has not yet been assessed because of the difficulty of realizing randomized prospective clinical trials. The theoretical advantage of an extended lateral lymphadenectomy is represented by an accurate staging of the tumour in patients undergoing surgery for possible curative resection; even if the high percentage (20 per cent) of pelvic node metastasis was already demonstrated, the prognostic impact of lateral lymphadenectomy was not proven until now. The results of the Literature demonstrated that an advanced rectal cancer can not be treated only by conventional surgery: radical surgery (with total mesorectal excision and pelvic lymphadenectomy) or, in alternative, a combined approach-chemo-radiotherapy+surgery-should-be applied in order to improve the 5-year survival and to reduce the percentage of local recurrence. With regard to surgery the main disadvantage for an extended lateral dissection is represented by the high incidence of urinary and sexual dysfunctions. The nerve-sparing technique, when combined to pelvic lymphadenectomy, allows preservation of autonomic innervation to the pelvis. The results of our experience demonstrated that nerve-sparing technique is an effective procedure that reduces the incidence of urinary and sexual dysfunctions when accurately performed.