Nerve Damage During Total Mesorectal Excision for Rectal Cancer May Lead to Anorectal and Urinary Dysfunction: Presented at ESSO

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Title: Nerve Damage During Total Mesorectal Excision for Rectal Cancer May Lead to Anorectal and Urinary Dysfunction: Presented at ESSO
URL: http://www.pslgroup.com/dg/22BE86.htm
Doctor's Guide
September 11, 2008

By Shazia Qureshi

THE HAGUE, Netherlands -- September 11, 2008 -- The frequently seen anorectal and urinary dysfunction following total mesorectal excision (TME) in rectal cancer patients may be attributable to surgical nerve damage, according to research findings reported here at the 14th Congress of the European Society of Surgical Oncology (ESSO).

Lead investigator Marilyne Lange, MSc, Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands, presented the study results on September 10.

Nerve damage in both the levator ani and in the pelvic splanchnic nerves can occur during TME surgery and both might result in urinary and faecal dysfunction, she noted.

For their study, Lange and colleagues evaluated patient questionnaires from the database of the Dutch TME trial.(1) In the original trial, patients with resectable rectal cancer underwent TME with or without preoperative radiotherapy.

A total of 651 patients filled out questionnaires both prior to their surgery and 5 years later. The questions were about faecal incontinence, urinary incontinence, and difficulties with bladder emptying.

Five years after TME surgery, 48.7% of patients reported having faecal incontinence, 39.5% had urinary incontinence, and 29.3% said they had difficulty with bladder emptying.

The investigators conducted multivariate regression analyses to evaluate possible risk factors for these symptoms.

For patients with faecal incontinence 5 years after surgery, the findings showed that preoperative faecal incontinence was a risk factor (P < .001, relative risk [RR] = 3.42), as were preoperative radiotherapy (P = .002, RR = 2.37), and low anastomotic level (P = .063, RR = 1.7).

Risk factors for urinary incontinence 5 years after surgery included preoperative incontinence (P = .017, RR = 2.44), being female (P = .001, RR = 2.34), age 65 years and older (P = .014, RR = 1.96), and anastomotic level <6 cm (P = .049, RR = 1.72).

In addition, the study showed that faecal incontinence and urinary incontinence were associated with each other (P = .027).

For difficulty with bladder emptying occurring 5 years after surgery, risk factors were surgical damage to the pelvic splanchnic nerves (P = .008, RR = 3.28), preoperative difficulty with bladder emptying (P < .001, RR = 3.15), and perioperative blood loss >1,500 mL (P = .038, RR = 1.95).

According to the study investigators, the low anastomotic level that was associated with both faecal and urinary incontinence might be an indication of nerve damage in the levator ani.

"Adhering to the surgical plane, reducing the use of blunt dissection and coagulation, and improving rectal retraction may lower the risk of nerve damage," Ms. Lange concluded.

1. Kapiteijn E et al. N Engl J Med. 2001;345:638-646.

[Presentation title: The Influence of Surgical Nerve Damage on Anorectal and Urinary Dysfunction After Rectal Cancer Treatment. Abstract 31]

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