Dissection of the inferior mesenteric vein versus of the inferior mesenteric artery for the genitourinary function after laparoscopic approach of rectal cancer surgery: a randomized controlled trial

Anna Pallisera-Lloveras, Paula Planelles-Soler, Naim Hannaoui, Laura Mora-López, Jesús Muñoz-Rodriguez, Sheila Serra-Pla, Arturo Dominguez-Garcia, Joan Prats-López, Salvador Navarro-Soto, Xavier Serra-Aracil, Tauli-Colorectal Cancer Study Group, Anna Pallisera-Lloveras, Laura Mora-López, Sheila Serra-Pla, Salvador Navarro-Soto, Xavier Serra-Aracil, Marta Hidalgo, Paula Planelles-Soler, Naim Hannaoui, Jesús Muñoz-Rodriguez, Arturo Dominguez-Garcia, Joan Prats-López, Carmen Del Pino, Carles Pericay, Ismael Macias, Eva Ballesteros, Àlex Casalots, Eva Martinez-Bauer, Anna Pallisera-Lloveras, Paula Planelles-Soler, Naim Hannaoui, Laura Mora-López, Jesús Muñoz-Rodriguez, Sheila Serra-Pla, Arturo Dominguez-Garcia, Joan Prats-López, Salvador Navarro-Soto, Xavier Serra-Aracil, Tauli-Colorectal Cancer Study Group, Anna Pallisera-Lloveras, Laura Mora-López, Sheila Serra-Pla, Salvador Navarro-Soto, Xavier Serra-Aracil, Marta Hidalgo, Paula Planelles-Soler, Naim Hannaoui, Jesús Muñoz-Rodriguez, Arturo Dominguez-Garcia, Joan Prats-López, Carmen Del Pino, Carles Pericay, Ismael Macias, Eva Ballesteros, Àlex Casalots, Eva Martinez-Bauer

Abstract

Background: Total Mesorectal Excision (TME) is the standard surgical technique for the treatment of rectal cancer. However, rates of sexual dysfunction ofup to 50% have been described after TME, and rates of urinary dysfunction of up to 30%. Although other factors are involved, the main cause of postoperative genitourinary dysfunction is intraoperative injury to the pelvic autonomic nerves. The risk is particularly high in the inferior mesenteric artery (IMA). The aim of this study is to compare pre- and post-TME sexual dysfunction, depending on the surgical approach usedin the inferior mesenteric vessels: either directly on the IMA, or from the inferior mesenteric vein (IMV) to the IMA.

Methods: Prospective, randomized,controlled study of patients with rectal adenocarcinoma with neoadjuvant chemoradiotherapy, who will be randomly assigned to one of two groups depending on the surgical approach to the inferior mesenteric vessels. The main variable is pre- and postoperative sexual dysfunction; secondary variables are visualization and preservation of the pelvic autonomic nerves, pre- and postoperative urinary dysfunction, and pre- and postoperative quality of life. The sample will comprise 90 patients, 45 per group.

Discussion: The aim is to demonstrate that the dissection route from the IMV towards the IMA favors the preservation of the pelvic autonomic nerves and thus reducesrates of sexual dysfunction post-surgery.

Trial registration: Ethical and Clinical Research Committee, Parc Taulí University Hospital: ID 017/315. ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018 (TRN: NCT03520088 ) (Date of registration 04/03/2018).

Keywords: Genitourinary dysfunction; Injury to the pelvic autonomic nerves; Rectal cancer; Total Mesorectal excision.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Outline of the pelvic autonomic nerves and their target organs
Fig. 2
Fig. 2
Proposed study schedule

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