gms | German Medical Science

Background: The purpose of pelvic intraoperative neuromonitoring (pIONM) is to maintain patients` quality of life. This study investigated the effect of pIONM on urogenital functional outcome following rectal cancer surgery.

Materials and methods: A consecutive series of 97 patients (68 males) undergoing total mesorectal excision (TME) for primary rectal cancer performed with and without pIONM was included. Patients participating in the NEUROS study (Grand number: KN 930/1-1) were excluded. Urogenital function was prospectively evaluated in both groups 3 and 6 months after stoma closure or 6 and 9 months after surgery in those with a permanent stoma (Follow up (FU) 1 and 2). Further visits followed 12 and 24 months postoperatively (FU 3 and 4). Urinary function was assessed with the International Prostate Symptom Score, Quality of life index and long-term catheterization rate. Sexual function was evaluated with the International Index of Erectile Function and the Female Sexual Function Index.

Results: pIONM controlled TME was performed in 47 of 97 patients. The pIONM-group had a lower number of incidences of postoperative urinary dysfunction compared to the Non-pIONM-group (FU 1, 16% vs. 45%, p=0.002; FU 2, 20% vs. 48%, p=0.004; FU 3, 18% vs. 45%, p=0.006; FU 4, 19% vs. 39%, p=0.033). Among the sexually active patients the pIONM-group (n=26) reported lower sexual dysfunction rates than the Non-pIONM-group (n=28), (FU 1, 38% vs. 68%, p=0.029; FU 2, 38% vs. 68%, p=0.029; FU 3, 38% vs. 70%, p=0.019; FU 4, 36% vs. 70%, p=0.013).

Conclusion: Univariate analysis revealed pIONM controlled TME to be associated with significant lower rates of newly developed urogenital dysfunction at short- and long-term FU.