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Effect of preservation of Denonvilliers ’ fascia during laparoscopic resection for mid-low rectal cancer on protection of male urinary and sexual functions

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to investigate the effect of preservation of Denonvilliers’ fascia (DF) during laparoscopic resection for mid-low rectal cancer on protection of male urogenital function. Whether preservation of DF during TME is effective for protection of urogenital function is largely elusive.

Seventy-four cases of male mid-low rectal cancer were included. Radical laparoscopic proctectomy was performed, containing 38 cases of preservation of DF (P-group) and 36 cases of resection of DF (R-group) intraoperatively. Intraoperative electrical nerve stimulation (INS) on pelvic autonomic nerve was performed and intravesical pressure was measured manometrically. Urinary function was evaluated by residual urine volume (RUV), International Prostatic Symptom Score (IPSS), and quality of life (QoL). Sexual function was evaluated using the International Index of Erectile Function (IIEF) scale and ejaculation function classification.

Compared with performing INS on the surfaces of prostate and seminal vesicles in the R-group, INS on DF in the P-group exhibited higher increasing intravesical pressure (7.3 ± 1.5 vs 5.9 ± 2.4 cmH2O, P = 0.008). In addtion, the P-group exhibited lower RUV (34.3 ± 27.2 vs 57.1 ± 50.7 mL, P = 0.020), lower IPSS and QoL scores (7 days: 6.1 ± 2.4 vs 9.5 ± 5.9, P = 0.002 and 2.2 ± 1.1 vs 2.9 ± 1.1, P = 0.005; 1 month: 5.1 ± 2.4 vs 6.6 ± 2.2, P = 0.006 and 1.6 ± 0.7 vs 2.1 ± 0.6, P = 0.003, respectively), higher IIEF score (3 months: 10.7 ± 2.1 vs 8.9 ± 2.0, P = 0.000; 6 months: 14.8 ± 2.2 vs 12.9 ± 2.2, P = 0.001) and lower incidence of ejaculation dysfunction (3 months: 28.9% vs 52.8%, P = 0.037; 6 months: 18.4% vs 44.4%, P = 0.016) postoperatively.

Preservation of DF during laparoscopic resection for selective male mid-low rectal cancer is effective for protection of urogenital function.

No MeSH data available.


Related in: MedlinePlus

Surgical plane behind Denonvilliers’ fascia (DF). In the P-group, dissection of peritoneum is performed 1 cm anterior superior to peritoneal reflection (PR), then the surgical plane (white dotted line) is dissected between DF and proper fascia of rectum (PFR).
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Figure 1: Surgical plane behind Denonvilliers’ fascia (DF). In the P-group, dissection of peritoneum is performed 1 cm anterior superior to peritoneal reflection (PR), then the surgical plane (white dotted line) is dissected between DF and proper fascia of rectum (PFR).

Mentions: The operation was performed under general anesthesia and the patients were placed in lithotomy position. For the R-group, sharp dissection was performed in front of DF. A U-shaped cut was applied to resect subtotal DF, whereas the lateral edges of DF were identified and preserved. However, in the P-group, transverse dissection of peritoneum was performed 1 cm anterior superior to peritoneal reflection (Fig. 1). Then as we found in the cadaver study (Fig. 2), some loose reticulate structures between DF and proper fascia of rectum would present (Fig. 3), and DF was well-identified as a glistening white surface of the anterior aspect during laparoscopic surgery. The surgical plane behind DF (retrofascial space) was carefully sharp dissected downward to preserve intact DF. Unlike the R-group, the prostate and bilateral seminal vesicles were covered by DF and cannot be observed in the P-group (Fig. 4).


Effect of preservation of Denonvilliers ’ fascia during laparoscopic resection for mid-low rectal cancer on protection of male urinary and sexual functions
Surgical plane behind Denonvilliers’ fascia (DF). In the P-group, dissection of peritoneum is performed 1 cm anterior superior to peritoneal reflection (PR), then the surgical plane (white dotted line) is dissected between DF and proper fascia of rectum (PFR).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998490&req=5

Figure 1: Surgical plane behind Denonvilliers’ fascia (DF). In the P-group, dissection of peritoneum is performed 1 cm anterior superior to peritoneal reflection (PR), then the surgical plane (white dotted line) is dissected between DF and proper fascia of rectum (PFR).
Mentions: The operation was performed under general anesthesia and the patients were placed in lithotomy position. For the R-group, sharp dissection was performed in front of DF. A U-shaped cut was applied to resect subtotal DF, whereas the lateral edges of DF were identified and preserved. However, in the P-group, transverse dissection of peritoneum was performed 1 cm anterior superior to peritoneal reflection (Fig. 1). Then as we found in the cadaver study (Fig. 2), some loose reticulate structures between DF and proper fascia of rectum would present (Fig. 3), and DF was well-identified as a glistening white surface of the anterior aspect during laparoscopic surgery. The surgical plane behind DF (retrofascial space) was carefully sharp dissected downward to preserve intact DF. Unlike the R-group, the prostate and bilateral seminal vesicles were covered by DF and cannot be observed in the P-group (Fig. 4).

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to investigate the effect of preservation of Denonvilliers’ fascia (DF) during laparoscopic resection for mid-low rectal cancer on protection of male urogenital function. Whether preservation of DF during TME is effective for protection of urogenital function is largely elusive.

Seventy-four cases of male mid-low rectal cancer were included. Radical laparoscopic proctectomy was performed, containing 38 cases of preservation of DF (P-group) and 36 cases of resection of DF (R-group) intraoperatively. Intraoperative electrical nerve stimulation (INS) on pelvic autonomic nerve was performed and intravesical pressure was measured manometrically. Urinary function was evaluated by residual urine volume (RUV), International Prostatic Symptom Score (IPSS), and quality of life (QoL). Sexual function was evaluated using the International Index of Erectile Function (IIEF) scale and ejaculation function classification.

Compared with performing INS on the surfaces of prostate and seminal vesicles in the R-group, INS on DF in the P-group exhibited higher increasing intravesical pressure (7.3 ± 1.5 vs 5.9 ± 2.4 cmH2O, P = 0.008). In addtion, the P-group exhibited lower RUV (34.3 ± 27.2 vs 57.1 ± 50.7 mL, P = 0.020), lower IPSS and QoL scores (7 days: 6.1 ± 2.4 vs 9.5 ± 5.9, P = 0.002 and 2.2 ± 1.1 vs 2.9 ± 1.1, P = 0.005; 1 month: 5.1 ± 2.4 vs 6.6 ± 2.2, P = 0.006 and 1.6 ± 0.7 vs 2.1 ± 0.6, P = 0.003, respectively), higher IIEF score (3 months: 10.7 ± 2.1 vs 8.9 ± 2.0, P = 0.000; 6 months: 14.8 ± 2.2 vs 12.9 ± 2.2, P = 0.001) and lower incidence of ejaculation dysfunction (3 months: 28.9% vs 52.8%, P = 0.037; 6 months: 18.4% vs 44.4%, P = 0.016) postoperatively.

Preservation of DF during laparoscopic resection for selective male mid-low rectal cancer is effective for protection of urogenital function.

No MeSH data available.


Related in: MedlinePlus