J.Jpn. Surg. Soc.. 83(9): 1015-1019, 1982
Report on the annual meeting
CRITICAL APPRAISAL OF RADICAL OPERATION FOR RECTAL CARCINOMA. IN VIEW OF POSTOPERATIVE URINARY AND ANAL DYSFUNCTION
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Second Department of Surgery, Kumamoto University Medical School Masakazu Matsuda, Masanobu Akagi, Atsunobu Misumi, Yohei Inamori, Hidechika Kawano, Fumio Sato, Yukimasa Goto, Sadamu Takano, Keisuke Araki, Nobuyuki Shigaki, Yoichi Ueno |
The postoperative urinary dysfunction was most frequent and severe in the patients underwent extended lateral lymphnode dissections. It seems reasonable to withhold this dissection in a selected case, such as a tumor located above the peritoneal reflection and judged as free from lymphnode involvement along the superior hemorrhoidal artery. When the anal margin of rectal cancer was oral to the reflection, the lateral lymphatic spread was rare, and if ever, no sole lateral lymphnode involvement lacking the upward spread was observed.
Ano-rectal dysfunction was uncommon after high anterior resection, but some were observed following other sphincter preserving operations. The chance and severity of functional disturbances occurring increased as the distance between suturing line and anal verge became shorter. In patients with the short rectal stump after pull-through operations, impairment of sphincteric continence was observed by anorectal manometry. If function of defecation is to be preserved in rectal resections, it seems necessary to retain not only the levator ani or sphincteric muscles but also intact rectal mucosa more than 3cm from the dentate line. In the patients with anal incontinence following low anterior resections few manometric abnormalities were observed, and the main reason of their frequency and urgency was the narrowing at the site of anastomosis and the loss of reservoir for faeces. It seems important to prevent the anastomotic stenosis upon the surgery.
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