Long-term survival and recurrences after total nerve-sparing surgery for rectal cancer

Background/Aims: In advanced extraperitoneal rectal cancer Japanese surgeons perform the lateral pelvic nodal dissection with only partial pelvic autonomic nerves preservation; instead most Western surgeons prefer the total mesorectal excision (TME) with complete pelvic nerve sparing except for evident neoplastic nervous involvement. Long-term oncological results of the total nerve-sparing TME are reported. Methodology: From January 1992 to October 1998 61 patients with extraperitoneal rectal carcinoma underwent TME with total nerve sparing except in two cases in which only a partial sparing was possible because of macroscopic neoplastic nervous infiltration: 54 anterior resections and 17 abdominoperineal resections were performed. Sixty-one curative-ly operated patients (9 stage I, 20 stage II, 29 stage III and 3 stage IV) were included. Results: No postoperative death occurred. Postoperative radiochemotherapy was performed in 31 cases, radiotherapy in 9 cases and chemotherapy in 9 cases. The mean follow-up was 98.7 months. The 5-year overall and disease-free survival rates were 88.8% and 77.7%, 90% and 75.1%, 62.3% and 45% for stage I, II and III respectively. The 8-year actuarial overall and disease-free survival rates were 77.7% and 77.7%, 78.3% and 75.1%, 50.4% and 40% for stage I, II and III respectively. Local failures with or without distant metastases were 6 (9.8%). Conclusions: Total nerve-sparing surgery is not contraindicated unless grossly neoplastic involvement is present.