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Hiroshi Shimada - One of the best experts on this subject based on the ideXlab platform.
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Metastasis of rectal cancer to lymph nodes and tissues around the autonomic nerves spared for urinary and sexual function
Diseases of the Colon & Rectum, 1997Co-Authors: Hideki Yamakoshi, Hideyuki Ike, Sigeo Oki, Masamichi Hara, Hiroshi ShimadaAbstract:PURPOSE: To clarify the indications for autonomic nerve-sparing operations for rectal cancer, the presence of lymph nodes and metastasis in the tissue around the autonomic nerve were examined in 28 rectal cancer patients. These were staged as pT2 in 8 patients, pT3 in 19 patients, and pT4 in 1 patient histopathologically. METHODS: The specimens of the autonomic nerve including the Inferior Mesenteric Plexus, preaortic Plexus, superior hypogastric Plexus, hypogastric nerve, and pelvic Plexus were removed with radical abdominopelvic lymphadenectomy after the autonomic nerve-sparing rectal cancer operation. RESULTS: In the tissue around the autonomic nerve, lymph nodes were 11.2±9.6 in number and 2.6±2.4 mm in size (mean ± standard deviation). The frequency of presence of lymph nodes was higher and the number of lymph nodes was larger in the Inferior Mesenteric Plexus (70.4 percent; 3.6) and the preaortic Plexus (66.7 percent; 2.1) than in the left and right pelvic Plexuses (39.1 percent, 1; 36 percent, 1). Metastasis to the lymph nodes or lymphatic permeation in the tissue around the autonomic nerve were observed in four cases (14.3 percent) of lower rectal cancer, consisting of three with Stage III cancer (pT3, pN1-3, and M0) and one with Stage IV cancer (pT4, pN1, and pM1 (HEP)). CONCLUSION: Radical rectal excision that includes lymph nodes and adjacent tissue around the autonomic nerves may result in metastatic tumor removal that would otherwise be left in situ with nerve-sparing techniques for advanced rectal cancer in Stage III .
Po-huang Lee - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic Pelvic Autonomic Nerve-Preserving Surgery for Patients with Lower Rectal Cancer after Chemoradiation Therapy
Annals of Surgical Oncology, 2007Co-Authors: Jin-tung Liang, Hong-shiee Lai, Po-huang LeeAbstract:Objective This is a phase II study, the aim of which is to determine if a laparoscopic approach can be used in pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer following chemoradiation therapy. Methods Patients with T3 lower rectal cancer treated by preoperative chemoradiation were recruited and subjected to laparoscopic pelvic autonomic nerve-preserving surgery with total mesorectal excision and a sphincter-saving procedure. This study was performed with the approval of the ethics committee of National Taiwan University Hospital. Because the quality of a surgical trial is highly dependent on the skill of the surgeon with respect to the technique under study, it is imperative that a surgical trial only be implemented after the surgical technique has been judged to be mature. Before the start of this clinical trial, we gained a sound knowledge of surgical anatomy through conventional open surgery for rectal cancer and mastered the related laparoscopic skills from other sound and proven laparoscopic approaches, including right hemicolectomy, left hemicolectomy, among others. We determined that the learning curve for this surgical technique necessitated that colorectal surgeons carry out at least 20 such procedures. At this point we conducted this clinical trial. The details of the surgical procedures have been shown in the attached video. Briefly, the dissection commences at the pelvic promontory with exposure and preservation of the superior hypogastric Plexus. The pre-aortic Plexus and Inferior Mesenteric Plexus are preserved by sparing the pre-aortic connective tissue and leaving a 1– to 2-cm-long stump of the Inferior Mesenteric artery in situ. Subsequently, the “holy plane” at the transition of the mesosigmoid to the mesorectum is meticulously dissected to progressively displace the hypogastric nerves dorsally and laterally and, therefore, preserving them. Following adequate dorsal and lateral dissection down to the floor of the pelvis, the so-called lateral ligament is reached at which the mesorectum appears to be adherent, anteriorly and laterally, to the Inferior hypogastric Plexus (at roughly 10:00–2:00 O’clock or within an angle of 60° about symphysis on both sides). The ligaments are divided immediately at the endopelvic fascia of the mesorectum to avoid damage to the Inferior hypogastric Plexus (pelvic Plexus). Finally, great care was taken to dissect the lateral border of Denonvilliers’ fascia where the Inferior hypogastric Plexus joins the neurovascular bundle described by Walsh. Postoperatively, only patients successfully operated on by total pelvic autonomic nerve-preserving surgery were included in the statistical analysis of surgical outcomes. Preoperatively, all patients were screened for their genitourinary function by a questionnaire-based interview. Patients with abnormal preoperative baseline functional data were excluded from further postoperative assessment of sexual or urinary function. The male sexual function was evaluated by potency and ejaculation. In female patients, the sexual function was assessed by vaginal lubrication, dyspareunia, sexual arousal, and orgasm. The reason for these four parameters is because the influence of pelvic autonomic nerve damage on female sexual function has been ambiguous but would most likely result in impairment of vaginal lubrication and congestion of the genitals. We evaluated sexual function at 6 months postoperatively, when the temporary colostomy had been closed and the patients were completely recovered from surgical disability. In evaluating urinary function, the duration between initial voiding trial and spontaneous voiding was recorded. The questionnaire used for the assessment of urinary dysfunction was based on the International Prostate Symptom Score and the following parameters from this Score were used: incomplete emptying, frequency, intermittency, urgency, week stream, straining, and nocturia. Any voiding problems recovered within 3 months after the operation were considered to be transient bladder voiding dysfunction; all other voiding problems were deemed persistent. The interview and scoring of the questionnaire were done by the research assistant blinded to operation procedures. The genitourinary function was ranked as good, fair (decreased), and poor (impaired). Results Between June 2003 and December 2005, a total of 98 patients (stage II: n = 44; stage III: n = 54; male: n = 50; female: n = 48) were enrolled in this study. Technically, although the dissection plane is a little blurred by preoperative chemoradiation therapy, the laparoscopic pelvic nerve-preserving procedure with total mesorectal excision was successfully performed in 89 (90.8%) patients with an acceptable operation time (284.4 ± 44.8 minutes; mean ± standard deviation) and little blood loss (114.5 ± 24 ml). The number of dissected lymph nodes was 16.4 ± 4.0. With respect to scrutiny of surgical specimens, the distal safety margin was adequate (mean: 2.4 cm; range: 1.2–5.6 cm), and the circumferential resection margins were free of tumor invasion (mean: 8.6 mm; range: 2–18 mm). A total of 74 patients completed the evaluation of urinary function. For these 74 patients, the median duration of training for the Foley catheter was 7 days (range: 4–64 days). The voiding function after removal of the Foley catheter were good in 53 (71.6%) patients, fair in 17 (23.0%), and poor in four (5.4%). Of the 17 patients with fair bladder function, eight were transient dysfunction and recovered thereafter. Thirty-two male and 28 female patients who were sexually active before the operation responded to the assessment of sexual function. In male patients, the ejaculation was good in 18 (56.3%) patients, fair (decrease in ejaculatory amounts) in six (18.7%), and poor (retrograde ejaculation, failure to ejaculate) in eight (25%). The potency was good in 20 (62.5%) patients, fair in five (15.6%), and poor in seven (21.9%). In female patients, the sexual function was good in 15 (53.6%) patients, fair in four (14.3%), and poor in nine (32.1%). Specific sexual problems in women included lubrication (46.6%, n = 13), dyspareunia (39.2%, n = 11), sexual arousal (28.6%, n = 8), and orgasm in (32.1%, n = 9). Conclusions By the laparoscopic approach, total preservation of pelvic autonomic nerves without compromise of the radical extirpation of tumor is technically feasible in the vast majority of patients with lower rectal cancer who have undergone concurrent chemoradiation therapy, thus facilitating the retention of genitourinary function in a significant proportion of such patients.
So-young Chung - One of the best experts on this subject based on the ideXlab platform.
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Inferior Mesenteric Plexus Block for Lower Abdominal Cancer Pain
The Korean Journal of Pain, 1993Co-Authors: Duck Mi Yoon, So-young ChungAbstract:Inferior Mesenteric Plexus block(IMPB) is a nerve block for lower abdominal pain originat- ing from GI tract of distal transverse colon to sigmoid colon and other polvic organ where the Inferior Mesenteric Plexus contains visceral afferent fibers of that organ. We performed IMPB on two patients with lower abdominal pain. Case I: 61 year old female diagnosed with cancer of stomach and uterine cervix and carcinomatosis, experienced complete relief from pain for a period of 7 months after IMPB. Case II: male, 28 years old, who had contracted cancer of the descending colon with obstruc- tive jaundice and pancreatitis had complained of pain in the whole of the abdominal area. IMPB was performed for lower abdominal pain. Seven days after, a celiac Plexus block was also performed for upper abdominal pain. The patient complained of recurring pain in the left & upper lower abdomen 30 days after the IMPB. The intensity of the pain was visual ana- logue scale 4 and it was managed by continuous epidural block. Conclusion: It is our recommendation that IMPB is a reliable method for treatment of lower abdominal pain originating from malignant condition of GI tract from distal transverse colon to sigmoid colon and urinary bladder.
Youngdeog Cha - One of the best experts on this subject based on the ideXlab platform.
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Inferior Mesenteric Plexus block performed in the lateral position
The Korean Journal of Pain, 1995Co-Authors: C S Kim, Youngdeog ChaAbstract:【Inferior Mesenteric Plexus block(IMPB) sa useful nerve block for the relief of intractable lower abdominal and pelvic pain caused by a lower abdominal visceral or a pelvic malignancy. IMPB has been performed in the prone position. But there are many patients who can't lie in the prone position, because ascites is frequently noticed in cancer patients and they also frequently received abdominal operations. We performed IMPB in the lateral position on two patients with lower abdominal pain, Case 1: A 77 year old female who had a right ovarian cancer with metastatic cancer of descending colon and rectum, experienced complete pain relief. Case 2: A 72 year old female who had a far advance pancreatic cancer with intestinal obstruction due to carcinomatosis received right and left celiac Plexus block and right and left IMPB. The patient was satisfied with the result of these pain blocks. Conclusion; IMAPB performed in the lateral position on two patients with lower abdominal pain and their results were excellent for pain relief.】
Hideki Yamakoshi - One of the best experts on this subject based on the ideXlab platform.
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Metastasis of rectal cancer to lymph nodes and tissues around the autonomic nerves spared for urinary and sexual function
Diseases of the Colon & Rectum, 1997Co-Authors: Hideki Yamakoshi, Hideyuki Ike, Sigeo Oki, Masamichi Hara, Hiroshi ShimadaAbstract:PURPOSE: To clarify the indications for autonomic nerve-sparing operations for rectal cancer, the presence of lymph nodes and metastasis in the tissue around the autonomic nerve were examined in 28 rectal cancer patients. These were staged as pT2 in 8 patients, pT3 in 19 patients, and pT4 in 1 patient histopathologically. METHODS: The specimens of the autonomic nerve including the Inferior Mesenteric Plexus, preaortic Plexus, superior hypogastric Plexus, hypogastric nerve, and pelvic Plexus were removed with radical abdominopelvic lymphadenectomy after the autonomic nerve-sparing rectal cancer operation. RESULTS: In the tissue around the autonomic nerve, lymph nodes were 11.2±9.6 in number and 2.6±2.4 mm in size (mean ± standard deviation). The frequency of presence of lymph nodes was higher and the number of lymph nodes was larger in the Inferior Mesenteric Plexus (70.4 percent; 3.6) and the preaortic Plexus (66.7 percent; 2.1) than in the left and right pelvic Plexuses (39.1 percent, 1; 36 percent, 1). Metastasis to the lymph nodes or lymphatic permeation in the tissue around the autonomic nerve were observed in four cases (14.3 percent) of lower rectal cancer, consisting of three with Stage III cancer (pT3, pN1-3, and M0) and one with Stage IV cancer (pT4, pN1, and pM1 (HEP)). CONCLUSION: Radical rectal excision that includes lymph nodes and adjacent tissue around the autonomic nerves may result in metastatic tumor removal that would otherwise be left in situ with nerve-sparing techniques for advanced rectal cancer in Stage III .