BACKGROUND Total Mesorectal Excision (TME) is the standard surgical technique for the treatment of rectal cancer. However, rates of sexual dysfunction ofup to 50% have been described after TME, and rates of urinary dysfunction of up to 30%. Although other factors are involved, the main cause of postoperative genitourinary dysfunction is intraoperative injury to the pelvic autonomic nerves. The risk is particularly high in the inferior mesenteric artery (IMA). The aim of this study is to compare pre- and post-TME sexual dysfunction, depending on the surgical approach usedin the inferior mesenteric vessels: either directly on the IMA, or from the inferior mesenteric vein (IMV) to the IMA. METHODS Prospective, randomized,controlled study of patients with rectal adenocarcinoma with neoadjuvant chemoradiotherapy, who will be randomly assigned to one of two groups depending on the surgical approach to the inferior mesenteric vessels. The main variable is pre- and postoperative sexual dysfunction; secondary variables are visualization and preservation of the pelvic autonomic nerves, pre- and postoperative urinary dysfunction, and pre- and postoperative quality of life. The sample will comprise 90 patients, 45 per group. DISCUSSION The aim is to demonstrate that the dissection route from the IMV towards the IMA favors the preservation of the pelvic autonomic nerves and thus reducesrates of sexual dysfunction post-surgery. TRIAL REGISTRATION Ethical and Clinical Research Committee, Parc Taulí University Hospital: ID 017/315. ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018 (TRN: NCT03520088 ) (Date of registration 04/03/2018).

中文翻译：

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腹腔镜直肠癌手术后，肠系膜下静脉与肠系膜下动脉的解剖对泌尿生殖功能的影响：一项随机对照试验。


背景全直肠系膜切除术（TME）是治疗直肠癌的标准手术技术。然而，TME 后性功能障碍的发生率高达 50%，泌尿功能障碍的发生率高达 30%。虽然也涉及其他因素，但术中盆腔自主神经损伤是导致术后泌尿生殖功能障碍的主要原因。肠系膜下动脉 (IMA) 的风险尤其高。本研究的目的是比较 TME 前后的性功能障碍，具体取决于肠系膜下血管使用的手术方法：直接在 IMA 上，或从肠系膜下静脉 (IMV) 到 IMA。方法 对接受新辅助放化疗的直肠腺癌患者进行前瞻性、随机、对照研究，根据肠系膜下血管的手术入路将患者随机分配至两组中的一组。主要变量是术前和术后性功能障碍；次要变量是盆腔自主神经的可视化和保留、术前和术后泌尿功能障碍以及术前和术后生活质量。样本将包括 90 名患者，每组 45 名。讨论 目的是证明从 IMV 到 IMA 的解剖路线有利于保留盆腔自主神经，从而减少术后性功能障碍的发生率。试验注册道德和临床研究委员会，Parc Taulí 大学医院：ID 017/315。 ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018（TRN：NCT03520088）（注册日期 04/03/2018）。