Preliminary Results of Pelvic Autonomic Nerve-preserving Surgery Combined with Intraoperative and Postoperative Radiation Therapy for Patients with Low Rectal Cancer

Background: /n Japan, latera/lymphadenectomy was widely performed for patients with stage II-III rectal tumors because it was thought to contribute to good local control, but the pelvic autonomic nerves were thus sacrificed. Although autonomic nerve-sparing surgery with lateral lymph nodedissection has beentried from around 1987,the typeof nervesparing variedandthe indications were not established. Toexamine the possibility of expanding the indications for total pelvicautonomic nervepreservation forpatients withlowrectal cancer, weconducted a pilotstudy. Methods: Between 1993and 1997,a total of 50 patients with low rectal cancerunderwent pelvic autonomic nerve preservation with lateral lymphadenectomy of both sides and intraoperative radiation therapyfollowed by postoperative radiation therapy. Results: The median follow-up period for surviving patients was 41 months. The 3-year local control rates for all patients,'with stage I-II and stage III tumors were 880/0 (95 % confidence interval, 78-97%), 97 % (90-100%) and73 % (52-94%), respectively. Thesiteof localrecurrences was not near or within the preserved plexus. Conclusions: The preliminary results showedgood local control rate for patients with stage I-II tumors. For patients with stage III tumors, the local control rate was unsatisfactory, but nerve sparing wasnotthecauseof localrecurrence. Further investigation of function-preserving surgery withoutdecreasing curability is needed