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International Journal of Colorectal Disease

Erschienen in:

08.03.2021 | Review

Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis

verfasst von: Athina A. Samara, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Symeonidis, Alexandros Diamantis, Konstantinos Tepetes

Erschienen in: International Journal of Colorectal Disease | Ausgabe 7/2021

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Abstract

Purpose

The aim of this study is to evaluate the role of pelvic intraoperative neuromonitoring (pIONM) in rectal cancer surgery.

Methods

A systematic review of the literature and a meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.

Results

Overall, nine studies were identified. Quantitative analysis was performed only in three trials. Bilateral pIONM improved postoperative anorectal and urogenital functional outcomes. However, unilateral pIONM displayed a significant effect only on erectile function (p = 0.001).

Conclusions

Our findings suggest a positive effect of pIONM on postoperative functional outcomes and quality of life after rectal cancer surgery. Due to several limitations, further trials are required in order to elucidate the exact role of pIONM.

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Kapiteijn E, Putter H, van de Velde CJH (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 89:1142–1149. https://doi.org/10.1046/j.1365-2168.2002.02196.xCrossRefPubMed

Ceelen WP, Van Nieuwenhove Y, Fierens K (2009) Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev:CD006041. https://doi.org/10.1002/14651858.CD006041.pub2

Nocera F, Angehrn F, von Flüe M, Steinemann DC (2020) Optimising functional outcomes in rectal cancer surgery. Langenbeck's Arch Surg. https://doi.org/10.1007/s00423-020-01937-5

Schiffmann L, Kostev K, Kalder M (2020) Fecal and urinary incontinence are major problems associated with rectal cancer. Int J Color Dis 35(1):35–40. https://doi.org/10.1007/s00384-019-03450-8CrossRef

Desnoo L, Faithfull S (2006) A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery. Eur J Cancer Care (Engl) 15(3):244–251. https://doi.org/10.1111/j.1365-2354.2005.00647.xCrossRef

Haim N, Wexner SD (2015) Rectal cancer-associated urinary dysfunction: a review. Curr Bladder Dysfunct Rep 10:118–124CrossRef

Attaallah W, Ertekin C, Tinay I, Yegen C (2014) High rate of sexual dysfunction following surgery for rectal cancer. Ann Coloproctol 30(5):210–215. https://doi.org/10.3393/ac.2014.30.5.210CrossRefPubMedPubMedCentral

Lange MM, Maas CP, Marijnen CA, Wiggers T, Rutten HJ, Kranenbarg EK, van de Velde CJ (2008 Aug) Cooperative clinical investigators of the Dutch Total Mesorectal Excision Trial. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 95(8):1020–1028. https://doi.org/10.1002/bjs.6126CrossRefPubMed

Kneist W, Kauff DW, Rubenwolf P, Thomas C, Hampel C, Lang H (2013) Intraoperative monitoring of bladder and internal anal sphincter innervation: a predictor of erectile function following low anterior rectal resection for rectal cancer? Results of a prospective clinical study. Dig Surg 30(4–6):459–465. https://doi.org/10.1159/000357349CrossRefPubMed

10.

Lange MM, Marijnen CA, Maas CP, Putter H, Rutten HJ, Stiggelbout AM, Meershoek-Klein Kranenbarg E, van de Velde CJ; Cooperative clinical investigators of the Dutch. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer 2009;45(9):1578–1588. doi: https://doi.org/10.1016/j.ejca.2008.12.014.

11.

Kauff DW, Lang H, Kneist W (2017) Risk factor analysis for newly developed urogenital dysfunction after total mesorectal excision and impact of pelvic intraoperative neuromonitoring-a prospective 2-year follow-up study. J Gastrointest Surg 21(6):1038–1047. https://doi.org/10.1007/s11605-017-3409-yCrossRefPubMed

12.

Kneist W, Kauff DW, Lang H (2014) Laparoscopic neuromapping in pelvic surgery: scopes of application. Surg Innov 21(2):213–220. https://doi.org/10.1177/1553350613496907CrossRefPubMed

13.

Kauff DW, Koch KP, Somerlik KH, Hoffmann KP, Lang H, Kneist W (2013) Evaluation of two-dimensional intraoperative neuromonitoring for predicting urinary and anorectal function after rectal cancer surgery. Int J Color Dis 28(5):659–664. https://doi.org/10.1007/s00384-013-1662-4CrossRef

14.

Kauff DW, Koch KP, Somerlik KH, Heimann A, Hoffmann KP, Lang H, Kneist W (2011) Online signal processing of internal anal sphincter activity during pelvic autonomic nerve stimulation: a new method to improve the reliability of intra-operative neuromonitoring signals. Color Dis 13(12):1422–1427. https://doi.org/10.1111/j.1463-1318.2010.02510.xCrossRef

15.

Kneist W, Kauff DW, Rahimi Nedjat RK, Rink AD, Heimann A, Somerlik K, Koch KP, Doerge T, Lang H (2010) Intraoperative pelvic nerve stimulation performed under continuous electromyography of the internal anal sphincter. Int J Color Dis 25(11):1325–1331. https://doi.org/10.1007/s00384-010-1015-5CrossRef

16.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

17.

Higgins JPT, Cochrane Collaboration (2019) Cochrane handbook for systematic reviews of interventions, 2nd edn. Wiley-Blackwell Publishing Ltd, Hoboken

18.

Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97. https://doi.org/10.1007/BF02050307CrossRefPubMed

19.

Denis L, Griffiths K, Khoury S (1998) Measuring the symptom and health impact of benign prostatic hyperplasia and its treatment. In: Denis L, Griffiths K, Khoury S et al (eds) 4th International consultation on benign prostatic hyperplasia. Health Publication, Paris, pp 265–280

20.

Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM (1999) Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 11:319–326CrossRefPubMed

21.

Wells GA, Shea B, O’connell D et al. (2011) The Newcastle– Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Department of Epidemiology and Community Medicine, University of Ottawa, Canada. Univ Ottawa, Canada. Available www.ohri.ca/progr ams/clinicalepidemiology/oxford.asp. Accessed 7th of Dec 2020

22.

Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13

23.

Jin D-J, Li Z-Y, Gu X-D, Zheng C, Zhou M-W, Chen Z-Y, Xiang J-B (2020) The value of intraoperative monitoring of pelvic autonomic nerves (IMPAN) during laparoscopic surgery for middle and low resection cancer. Fudan Univ J Med Sci 47(5):669–678

24.

Kauff DW, Roth YDS, Bettzieche RS, Kneist W (2020) Fecal incontinence after total mesorectal excision for rectal cancer-impact of potential risk factors and pelvic intraoperative neuromonitoring. World J Surg Oncol 18(1):12. https://doi.org/10.1186/s12957-020-1782-6CrossRefPubMedPubMedCentral

25.

Zhou MW, Huang XY, Chen ZY, Li ZY, Zhou YM, Yang Y, Wang ZH, Xiang JB, Gu XD (2018) Intraoperative monitoring of pelvic autonomic nerves during laparoscopic low anterior resection of rectal cancer. Cancer Manag Res 11:411–417. https://doi.org/10.2147/CMAR.S182181CrossRefPubMedPubMedCentral

26.

Kauff DW, Wachter N, Bettzieche R, Lang H, Kneist W (2016) Electrophysiology-based quality assurance of nerve-sparing in laparoscopic rectal cancer surgery: is it worth the effort? Surg Endosc 30(10):4525–4532. https://doi.org/10.1007/s00464-016-4787-zCrossRefPubMed

27.

Kneist W, Kauff DW, Juhre V, Hoffmann KP, Lang H (2013) Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME? Results of a case-control study. Eur J Surg Oncol 39(9):994–999. https://doi.org/10.1016/j.ejso.2013.06.004CrossRefPubMed

28.

Kneist W, Kauff DW, Gockel I, Huppert S, Koch KP, Hoffmann KP, Lang H (2012) Total mesorectal excision with intraoperative assessment of internal anal sphincter innervation provides new insights into neurogenic incontinence. J Am Coll Surg 214(3):306–312. https://doi.org/10.1016/j.jamcollsurg.2011.11.013CrossRefPubMed

29.

Kneist W, Heintz A, Junginger T (2004) Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer. J Am Coll Surg 198(1):59–66. https://doi.org/10.1016/j.jamcollsurg.2003.09.004CrossRefPubMed

30.

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 69(10):613–616. https://doi.org/10.1002/bjs.1800691019CrossRefPubMed

31.

Yamamoto S (2020) Comparison of the perioperative outcomes of laparoscopic surgery, robotic surgery, open surgery, and transanal total mesorectal excision for rectal cancer: an overview of systematic reviews. Ann Gastroenterol Surg 4(6):628–634. https://doi.org/10.1002/ags3.12385CrossRefPubMedPubMedCentral

32.

Eldamshety O, Kotb S, Khater A, Roshdy S, Elashry M, Zahi MS, Elkalla HMHR, Elnahas W, Farouk O, Fathi A, Senbel A, Hamed EE, Abdelwahab K, Elzahby IA, Abdallah A, Abdelaziz M, Lezoche E (2020) Early and late functional outcomes of anal sphinctersparing procedures with total mesorectal excision for anorectal adenocarcinoma. Ann Coloproctol 36(3):148–154. https://doi.org/10.3393/ac.2018.07.19CrossRefPubMedPubMedCentral

33.

Rubinkiewicz M, Zarzycki P, Witowski J, Pisarska M, Gajewska N, Torbicz G, Nowakowski M, Major P, Budzyński A, Pędziwiatr M (2019) Functional outcomes after resections for low rectal tumors: comparison of Transanal with laparoscopic Total Mesorectal excision. BMC Surg 19(1):79. https://doi.org/10.1186/s12893-019-0550-4CrossRefPubMedPubMedCentral

34.

Kneist W, Rink AD, Kauff DW, Konerding MA, Lang H (2015) Topography of the extrinsic internal anal sphincter nerve supply during laparoscopicassisted TAMIS TME: five key zones of risk from the surgeons’ view. Int J Color Dis 30(1):71–78CrossRef

35.

Scheer AS, O’Connor AM, Chan BP (2012) The myth of informed consent in rectal cancer surgery: what do patients retain? Dis Colon Rectum 55(9):970–975CrossRefPubMed

36.

Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM, Cantor SB, Chang GJ (2015) Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975–2010. JAMA Surg 150(1):17–22. https://doi.org/10.1001/jamasurg.2014.1756 Erratum in: JAMA Surg. 2015 Mar 1;150(3):277CrossRefPubMedPubMedCentral

37.

Chew MH, Yeh YT, Lim E, Seow-Choen F (2016) Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf) 4(3):173–185. https://doi.org/10.1093/gastro/gow023CrossRef

38.

Phang PT (2004) Total mesorectal excision: technical aspects. Can J Surg 47(2):130–137PubMedPubMedCentral

39.

Hasegawa S, Nagayama S, Nomura A, Kawamura J, Sakai Y (2008) Autonomic nerve-preserving total mesorectal excision in the laparoscopic era. Dis Colon Rectum 51:1279–1282. https://doi.org/10.1007/s10350-008-9352-yCrossRefPubMed

40.

Costanzi A, Rigamonti L, Mari GM, Miranda A, Crippa J, Berardi V, Maggioni D (2015) A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer. Surg Endosc 29(7):1721–1728. https://doi.org/10.1007/s00464-014-3876-0CrossRefPubMed

41.

Kauff DW, Kronfeld K, Gorbulev S, Wachtlin D, Lang H, Kneist W (2016) Continuous intraoperative monitoring of pelvic autonomic nerves during TME to prevent urogenital and anorectal dysfunction in rectal cancer patients (NEUROS): a randomized controlled trial. BMC Cancer 16:323. https://doi.org/10.1186/s12885-016-2348-4CrossRefPubMedPubMedCentral

42.

Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645. https://doi.org/10.1016/S1470-2045(10)70131-5CrossRefPubMed

43.

Andersson J, Angenete E, Gellerstedt M, Angerås U, Jess P, Rosenberg J, Fürst A, Bonjer J, Haglind E (2013) Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial [published correction appears in Br J Surg. 2016 Nov;103(12 ):1746]. Br J Surg 100(7):941–949. https://doi.org/10.1002/bjs.9144CrossRefPubMedPubMedCentral

44.

Dulskas A, Kavaliauskas P, Pilipavicius L, Jodinskas M, Mikalonis M, Samalavicius NE (2020) Long-term bowel dysfunction following low anterior resection. Sci Rep 10:11882. https://doi.org/10.1038/s41598-020-68900-8CrossRefPubMedPubMedCentral

45.

Pieniowski EHA, Nordenvall C, Palmer G, Johar A, Tumlin Ekelund S, Lagergren P, Abraham-Nordling M (2020) Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study. BJS Open 4(5):935–942. https://doi.org/10.1002/bjs5.50312CrossRefPubMedPubMedCentral

46.

van der Heijden JAG, Koëter T, Smits LJH et al (2020) Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis. Br J Surg 107(5):489–498. https://doi.org/10.1002/bjs.11566CrossRefPubMedPubMedCentral

47.

Ridolfi TJ, Berger N, Ludwig KA (2016) Low anterior resection syndrome: current management and future directions. Clin Colon Rectal Surg 29(3):239–245. https://doi.org/10.1055/s-0036-1584500CrossRefPubMedPubMedCentral

Titel: Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis
verfasst von: Athina A. Samara
Ioannis Baloyiannis
Konstantinos Perivoliotis
Dimitrios Symeonidis
Alexandros Diamantis
Konstantinos Tepetes
Publikationsdatum: 08.03.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: International Journal of Colorectal Disease / Ausgabe 7/2021
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-021-03884-z

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