Our Summary

This research paper is about avoiding injuries to the urinary and reproductive organs during surgery to remove the rectum (proctectomy) for patients with non-spreading rectal cancer. This is important because such injuries can lead to problems with urination or sexual function, longer recovery times, and possibly more surgery.

The researchers looked at data from over 2500 patients who had this surgery between 2016 and 2019. They compared patients who had the surgery done the traditional way, with a large open incision (open proctectomy), to those who had it done with a less invasive method using small incisions and a camera (laparoscopic proctectomy).

They found that patients who had the traditional surgery were more likely to have other health problems before the surgery and were more likely to have injuries to the urinary and reproductive organs. However, those who had the less invasive surgery were 51.4% less likely to have these kinds of injuries.

They also found that patients who lost more than 10% of their body weight in the 6 months before surgery or had severe systemic disease (ASA class 3) were more likely to have these injuries, regardless of the type of surgery they had.

In simpler terms, the research suggests that the less invasive surgery is associated with fewer injuries to the urinary and reproductive organs. However, patients who are severely ill or have lost a lot of weight before surgery are at a higher risk for these injuries.

FAQs

  1. What is the risk of genitourinary injuries (GUIs) in patients undergoing laparoscopic proctectomy compared to open proctectomy?
  2. Are there certain factors that can increase a patient’s risk of GUI during a proctectomy?
  3. Can weight loss or severe systemic disease affect the risk of genitourinary injuries during a proctectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to maintain a healthy weight and overall health before undergoing the procedure. Patients who have lost more than 10% of their body weight in the past 6 months or who have severe systemic disease (ASA class 3) are at a higher risk of genitourinary injuries during proctectomy. By ensuring good overall health and weight management, patients can potentially reduce their risk of complications during the surgery.

Suitable For

Patients who are typically recommended for proctectomy include those with non-metastatic rectal cancer who may benefit from surgical removal of the rectum. Additionally, patients with significant preoperative comorbidities, such as >10% body weight loss in the past 6 months and ASA class 3 status (Severe Systemic Disease), may also be candidates for proctectomy. It is important to consider the risk of genitourinary injuries (GUIs) in these patients, as factors such as operative approach (laparoscopic vs. open) can impact the likelihood of sustaining a GUI. Patients who undergo a laparoscopic proctectomy may have a lower risk of GUI compared to those who undergo an open operation.

Timeline

Before proctectomy:

  1. Diagnosis of non-metastatic rectal cancer
  2. Preoperative evaluation and assessment of comorbidities
  3. Decision-making process regarding surgical approach (laparoscopic or open)
  4. Preparation for surgery, including bowel cleansing and dietary restrictions

After proctectomy:

  1. Recovery period in the hospital, monitoring for complications
  2. Postoperative pain management
  3. Gradual resumption of normal activities and diet
  4. Follow-up appointments with healthcare providers for monitoring and surveillance
  5. Rehabilitation and physical therapy, if necessary
  6. Potential long-term effects on genitourinary function, such as urinary or sexual dysfunction

Overall, the timeline for a patient undergoing proctectomy involves a comprehensive preoperative evaluation, surgical intervention, and postoperative care to ensure successful recovery and minimize complications.

What to Ask Your Doctor

  1. What is a proctectomy and why is it being recommended for me?
  2. What are the different types of proctectomy procedures and which one is most suitable for my condition?
  3. What are the potential risks and complications of a proctectomy, particularly in relation to genitourinary injuries?
  4. How experienced are you in performing proctectomies and what is your success rate in avoiding genitourinary injuries?
  5. What are the steps taken during surgery to minimize the risk of genitourinary injuries?
  6. How long is the recovery process after a proctectomy and what can I expect in terms of urinary or sexual function post-surgery?
  7. Are there any specific lifestyle changes or precautions I should take following a proctectomy to prevent genitourinary complications?
  8. What follow-up appointments or tests will be necessary to monitor for potential genitourinary issues after the surgery?
  9. Are there any alternative treatment options to a proctectomy that I should consider?
  10. Are there any additional resources or support groups available for patients undergoing a proctectomy?

Reference

Authors: Roskam JS, Pourghaderi P, Soliman SS, Chang GC, Rolandelli RH, Nemeth ZH. Journal: Am Surg. 2023 Dec;89(12):5927-5931. doi: 10.1177/00031348231175450. Epub 2023 Jun 1. PMID: 37260109