[Comment] Effect of denonvilliers’fascia preservation versus resection dur ing laparoscopic total mesorectal excision on postoperative urogenital function of male rectal cancer patients:initial re sults of Chinese PUF-01 Randomized Clinical Trial
[Objective] To compare the outcomes of laparoscopic total mesorectal excision (L-TME) with Denonvilliers' fascia (DVF) preservation versus resection on urogenital function of male patients with rectal cancer. [Background] The protective effect of DVF during L-TME on pelvic autonomic nerves and...
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| Format: | Article |
| Language: | zho |
| Published: |
Editorial Office of Journal of Colorectal & Anal Surgery
2022-06-01
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| Series: | 结直肠肛门外科 |
| Online Access: | https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=417&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC3%E6%9C%9F |
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| Summary: | [Objective] To compare the outcomes of laparoscopic total mesorectal excision (L-TME) with Denonvilliers' fascia (DVF) preservation versus resection on urogenital function of male patients with rectal cancer. [Background] The protective effect of DVF during L-TME on pelvic autonomic nerves and postoperative urogenital function remains controversial. [Methods] Between August 26, 2015 and July 18, 2019, 253 male patients with cT1-4 (T1-2 for anterior wall) N0-2M0 rectal cancer from 11 institutions were enrolled, and randomly assigned to L-TME with DVF preservation (Exp-group, n = 123) or resection procedures (Con-group, n = 130). Urinary function was assessed by residual urine volume, maximal flow rate, and International Prostate Symptom Score; sexual function was assessed by 5-item version of the International Index of Erectile Function (IIEF-5) and ejaculation grading. [Results] The Exp-group patients showed a lower urinary dysfunction rate (6.8% vs 25.4%, P = 0.003), higher maximal flow rate (16.25 ± 8.02 vs 12.40 ± 7.05 mL/s, P = 0.007), and lower International Prostate Symptom Score (6.55 ± 5.86 vs 8.57 ± 5.85, P = 0.026) than the Con-group patients at 2 weeks after surgery. The incidence of erectile dysfunction (IIEF-5 ≤ 11) at 12 months after surgery was lower in the Exp-group than in the Con-group (12.5% vs 34.2%, P = 0.023); Exp-group manifested superior IIEF-5 (16.63 ± 6.28 vs 12.26 ± 6.83, P = 0.018). The incidence of ejaculation dysfunction was lower in the Exp-group than in the Con-group at 12 months after surgery (10.0% vs 29.4%, P = 0.034). [Conclusions] DVF preservation during L-TME revealed protective effects on postoperative urogenital function, and could be a better choice for male rectal cancer patients with specific staging and location. |
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| ISSN: | 1674-0491 |