Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer Journal Article


Authors: Enker, W. E.; Havenga, K.; Polyak, T.; Thaler, H.; Cranor, M.
Article Title: Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer
Abstract: We have examined the results of abdominoperineal resection (APR) for primary Cancer of the rectum performed in accordance with the principles of total mesorectal excision (TME) and autonomic nerve preservation (ANP). TME is defined as sharp pelvic dissection under direct vision between the parietal and visceral planes of the pelvic fascia. TME results in the resection of all mesorectal disease with intact, negative lateral or circumferential margins of resection. Statistical analysis was done of survival, local recurrence, and both sexual and urinary functions in a prospective database of consecutive patients. Operative mortality was 2%(3/148) due to cardiac disease. Overall survival was 60%, significantly worse than consecutive patients from the same data-base who were able to Undergo sphincter preservation (81%) (p = 0.0003). Poorer survive was statistically related to the presence of positive lymph nodes (p = 0.0009). Overall, local recurrence rates were 5% (8/148) in patients without distant metastases, and 15% to 21% in patients with positive nodes. Positive lymph nodes, N2 disease, lymphatic vascular invasion, and perineural invasion were independent significant risk factors for local recurrence. Sexual function was preserved in approximately 57% of patients undergoing APR versus 85% of patients undergoing sphincter preservation. No significant urinary morbidity was encountered. Low rectal cancer requiring APR seems to be a disease with more locally advanced disease and adverse pathologic features than are seen with mid-rectal cancers treatable by low anterior resection. APR when performed in accordance with the principles of TME and ANP ensures the greatest likelihood of resecting all regional disease while preserving both sexual and urinary functions. Preoperative combined modality treatment may be warranted in all T3 or greater low rectal cancers.
Keywords: adult; cancer survival; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; surgical technique; survival rate; retrospective studies; major clinical study; review; lymph node metastasis; neoplasm recurrence, local; risk factors; surgical approach; postoperative complication; sexual dysfunction; surgical mortality; surgical procedures, operative; rectal neoplasms; rectum cancer; sex; rectum; rectum abdominoperineal resection; urination; autonomic nervous system; humans; human; male; female
Journal Title: World Journal of Surgery
Volume: 21
Issue: 7
ISSN: 0364-2313
Publisher: Springer  
Date Published: 1997-09-01
Start Page: 715
End Page: 720
Language: English
DOI: 10.1007/s002689900296
PUBMED: 9276702
PROVIDER: scopus
DOI/URL:
Notes: Review -- Export Date: 17 March 2017 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Tatyana A Polyak
    10 Polyak
  2. Howard T Thaler
    243 Thaler
  3. Milicent Cranor
    48 Cranor
  4. Warren E. Enker
    69 Enker