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Warren E. Enker, MD

Arch Surg. 1992;127(12):1396-1402.

Abstract
• Impotence due to parasympathetic nerve injury is one of the most feared consequences of operations for treatment of rectal cancer. Sharp dissection along the parietal pelvic fascia where the parasympathetic nerves are located significantly reduces the incidence of pelvic failure. Autonomic nerve—preserving pelvic sidewall dissections, which combined the benefits of en bloc parietal pelvic dissection with nerve preservation, were performed in 42 men who were undergoing sphincter-preserving operations for treatment of rectal cancer. Thirty-three (86.7%) of the 38 evaluable patients have remained potent, and 29 (87.9%) of the 33 patients have normal ejaculation. Deliberate sacrifice of the inferior hypogastric plexus caused only minor sexual dysfunction. Cancer recurred locally in only one patient (with stage D cancer). Autonomic nerve—preserving pelvic sidewall dissection combines the benefits of curative resection and local control with reduced morbidity, and it preserves potency.

(Arch Surg. 1992;127:1396-1402)

Author Affiliations
From the Colorectal Service, Memorial Sloan-Kettering Cancer Center, and the Department of Surgery, Cornell University Medical College, New York, NY.

Footnotes
Accepted for publication August 8, 1992.

Presented at the 45th Annual Cancer Symposium of the Society for Surgical Oncology, New York, NY, March 17, 1992.

Reprint requests to Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (Dr Enker).

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