J.Jpn. Surg. Soc.. 98(3): 385-390, 1997

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Feature topic

THE AUTONOMIC NERVE PRESERVING RADICAL RESECTION FOR THE PATIENTS WITH LOWER RECTAL CANCER

From 1988, we have begun the autonomic nerve preserving radical lymph adenectomy for the patients with lower rectal advanced cancer. The most important point to perform this method is the correct and well acquinted anatomical knowledge with the lower pelvis especially for the lateral area and distal area of internal iliac aretery. Although there is some possibility that the cancer cells remain around the nerve system in the case of advanced cancer with lymph node imvolving, the sharp dissection can be possible to achieve the radical lymphadenectomy with autonomic nerve preserving in lateral area. The 5 years survival rate of the total cases which was consisted with more than 40％ of Dukes C cases was 83％ and that of the patients with lateral lymph node metastasis was 56％. The local recurrence rate was 3.4％ in all cases, and 7.2％ in Dukes C cases. Concerning with post operative urinary function, the urinary function was excellent when the bi-lateral nerve system was preserved and fare in uni-lateral preservation. But as to the sexual function in male patients was not satisfactory in uni-lateral preservation, and fare in bi-lateral preservation.

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