Indication of Autonomic Nerve Preserving Operation for Rectal Cancer on Lateral Node Dissection

Abstract

Lateral node metastasis, recurrence, and outcome were investigated in rectal cancer with and without autonomic nerve-preserving operation to clarify the effect of autonomic nerve-preserving operation on lateral node dissection. All patients undergoing curative surgery for middle and lower rectal cancer were classified into the following three groups : a group that underwent autonomic nerve non-preserving operation from 1980 and 1987 (group A, n=109), a group that underwent the nerve-preserving operation between 1988 and 1993 (group B, n=71), and a group that underwent non-preserving operation between 1988 and 1993 (group C, n=12). Our indications for nerve preservation since 1988 have been the absence of evidence of direct invasion of the autonomic nerve macroscopically in frozen sections during surgery. The 5-year survival rate of all cases with and without node metastasis was 33.8% and 76.8% respectively. There were no statistically significant differences in the 5-year survival rate between groups A and B according to Duke's staging, staging by the General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus, and recurrence rate. However, the cumulative 5-year survival rate in group B was significantly better than in group A (P<0.05) in the lower rectum. There were no significant differences between group A and groups B and C in the 5-year survival rate. The 5-year survival rate in group B was significantly better than in group C (P<0.05). The autonomic nerve-preserving operation with lateral node dissection was concluded to provide as good an outcome as non-preserving operations with lateral node dissection within our indications.