Kauff Daniel W, Lang Hauke, Kneist Werner
Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
J Gastrointest Surg. 2017 Jun;21(6):1038-1047. doi: 10.1007/s11605-017-3409-y. Epub 2017 Apr 4.
Urogenital dysfunction is a common sequela following total mesorectal excision for rectal cancer. This prospective study analyzed potential risk factors and investigated the impact of pelvic intraoperative neuromonitoring.
Included were 85 patients undergoing total mesorectal excision for rectal cancer, 43 under the control of pelvic intraoperative neuromonitoring. Urogenital function was assessed with validated questionnaires within a 2-year follow-up period. Potential risk factors were identified by multivariate analysis.
Overall, approximately one-third of treated patients suffered from new onset of urinary dysfunction. Initially, half of the sexually active patients were affected by sexual dysfunction; after 2 years, almost three quarters were affected. In the pelvic intraoperative neuromonitoring group, urinary and sexual dysfunction rates including minor and major disturbances were significantly lower (2-year follow-up 20% vs. 51% (p = 0.004) and 56% vs. 90% (p = 0.010)). Throughout the survey, non-performance of pelvic intraoperative neuromonitoring was found to be an independent risk factor. Neoadjuvant chemoradiotherapy was identified as an independent predictor for urogenital dysfunction in the further course one and 2 years after surgery.
Pelvic intraoperative neuromonitoring is associated with significantly lower rates of urinary and sexual dysfunction in the short and long run, whereas neoadjuvant chemoradiotherapy has a negative impact only in the long run.
泌尿生殖功能障碍是直肠癌全直肠系膜切除术后常见的后遗症。本前瞻性研究分析了潜在风险因素，并研究了盆腔术中神经监测的影响。
纳入85例行直肠癌全直肠系膜切除术的患者，其中43例在盆腔术中神经监测下进行手术。在2年随访期内，通过经过验证的问卷对泌尿生殖功能进行评估。通过多变量分析确定潜在风险因素。
总体而言，约三分之一的接受治疗的患者出现了新发排尿功能障碍。最初，一半有性生活的患者受到性功能障碍的影响；2年后，近四分之三的患者受到影响。在盆腔术中神经监测组中，包括轻微和严重干扰在内的泌尿和性功能障碍发生率显著较低（2年随访时分别为20%对51%（p=0.004）和56%对90%（p=0.010））。在整个调查中，未进行盆腔术中神经监测被发现是一个独立的风险因素。新辅助放化疗被确定为术后1年和2年后续过程中泌尿生殖功能障碍的独立预测因素。
盆腔术中神经监测在短期和长期内均与显著较低的泌尿和性功能障碍发生率相关，而新辅助放化疗仅在长期内有负面影响。
