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).
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http://dx.doi.org/10.1186/s12894-019-0501-5 | DOI Listing |
Clin J Gastroenterol
December 2024
Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
We report the case of a 70-year-old woman with advanced hepatic encephalopathy (HE) secondary to metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis who exhibited an excellent response to portosystemic shunt embolization. Four years earlier, she was diagnosed as having MASH-related cirrhosis accompanied by multiple mesenteric vein-inferior vena cava shunts. As her condition progressed, she suffered recurrent HE that was unresponsive to oral medication, prompting the decision to proceed with shunt embolization.
View Article and Find Full Text PDFWorld J Surg Oncol
December 2024
Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
Objective: The primary objective of this study was to identify the risk of metastasis to lymph nodes above the inferior mesenteric artery (IMA) in endometrioid-type endometrial cancer (EC) and the factors that influence metastasis.
Methods: The study included patients who had been operated on for endometrioid-type EC in three gynecological oncology centers between 2007 and 2023. The supramesenteric lymph node (SM-LN) is the region between the left renal vein and the IMA, whereas the inframesenteric lymph node (IM-LN) is the region between the IMA and the aortic bifurcation, as determined by the level of the IMA.
Int J Surg Case Rep
December 2024
Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Biomedical Sciences, Jimma, Ethiopia. Electronic address:
Introduction And Importance: Sclerosing angiomatoid nodular transformation of the spleen is a rare benign vascular lesion arising from red pulp of spleen with unknown etiopathogenesis. It is a non-neoplastic condition that affects the spleen only; not described in other sites except one case reported in adrenal gland. Epidemiologically it has slight female predilection.
View Article and Find Full Text PDFCureus
November 2024
Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.
Proximal splenorenal shunt is the most commonly performed shunt in patients with extrahepatic portal venous obstruction (EHPVO). Sometimes, due to various anatomical and intraoperative factors, other rarely used shunts may be required. We present the case of a 27-year-old male who was diagnosed with EHPVO with complicated portal cavernomatous cholangiopathy.
View Article and Find Full Text PDFCancers (Basel)
December 2024
Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8603, Japan.
Background: With the advent of effective chemotherapy, conversion surgery (CS) has been performed in patients who have responded to pretreatment, even for pancreatic cancer diagnosed as unresectable (UR) at the time of initial diagnosis. In CS, major arterial resection and reconstruction are necessary for complete radical resection.
Methods: We discuss the key points for safely performing pancreatectomy with celiac axis (CA) resection combined with reconstruction, divided into resection and arterial reconstruction.
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