الفهرس 
Pelvic autonomic nerveOnly 14 pages are availabe for public view
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Abstract
The main objectives of surgery for rectal cancer are cure and the prevention of local or pelvic recurrence. Preservation of pelvic autonomic functions are important associated goals that have influenced the design of the operation. Patient & Methods: In our study, 40 patients presented with cancer rectum were divided into two groups, one group was subjected to total mesorectal excision and pelvic nerve preservation, And second group was subjected to subtotal mesorectal excision with conventional method.All patients have undergone routine investigations and metastatic workup before operation.Patients were followed up for at least 2 years considering history, physical examination, and measurement of Carcinoembryonic antigen (CEA) values done thrice yearly with chest radiograph and liver ultrasound every six months.A follow up CT pelvis was also done at a year postoperatively.All patients were asked to fill out a questionnaire with questions regarding urinary function and the male patients were asked to fill out a questionnaire with questions regarding sexual function. All patients were subjected to urinary flowmetry to assess the urinary function and the male patients were subjected to U/S color Doppler to assess the male sexual function. Results :20 patients with total mesorectal excision showed no cumulative risk of local recurrence at two years while the other 20 patients with subtotal mesorectal excision and conventional method showed 30 % cumulative risk of local recurrence. Our study reported that in patients subjected to total mesorectal excision with pelvic nerve preservation, 85 % of patients did not report any urinary complaint. The other patients ( 15 % ) experienced one or more of the early urinary symptoms such as pain, burning or discomfort during urination; or increased frequency. Postoperative flowmetry revealed normal mean maximal urinary flow rate and voided volume in 90 % of patients. 10 % of patients revealed mean maximal urinary flow rate less than 10 ml / sec and voided volume less than 300 ml. No patients revealed neurogenic bladder requiring catheterization nor patients revealed residual urine.while in patients subjected to subtotal mesorectal excision with conventional method, 50 % only did not report any urinary complaint and the other 50 % reported urinary complaint. Postoperative flowmetry revealed normal menn maximal urinary flow rate and voided volume in 65 % of patients.4 patients revealed neurogenic bladder requiring catheterization.Among 5 male patients subjected to total mesorectal excision and pelvic nerve preservation, by using a standard questionnaire, one patient only ( 20 % ) showed complete inability for erection and intercourse. Erection and penetration ability was possible in 4 patients ( 80 % ). Doppler US was performed to the five male patients which revealed normal biphasic arterial and venous pulsations on both sides in 4 patients ( 80 % ) and abnormal in only one patient ( 20 % ).Among 8 male patients subjected to subtotal mesorectal excision with conventional method , by using a standard questionnaire, 4 patients ( 50 % ) showed abnormal sexuality. Doppler US revealed normal biphasic arterial and venous pulsations in both sides in 4 patients ( 50 % ) and abnormal in 4 patients ( 50 % ).Conclusion the introduction of total mesorectal excision (TME) with pelvic nerve preservation (ANP) is one of the largest improvements in the outcome of rectal cancer.We recommended TME ANP to improve not only prognosis in terms of local recurrence, but also in terms of overall survival and preserving urinary and sexual activities.