Concurrent Chemoradiation Versus Wide Pelvic Lymphadenectomy for Advanced Rectal Cancer

Based on the neurophysiology, it is well known that sympathetic nerves control the ejaculatory function and bladder neck closure. In contrast, the parasympathetic nerves control penile erection and bladder wall contraction. Because of the difference in cultural background of the patients and training background of the physicians between Western and Oriental Countries, the Western people did not believe in the efficacy of wide pelvic lymphadenectomy. In the Oriental countries, due to the shortage of standardized facilities, treatment protocol, and manpower, the concurrent preoperative chemoradiation therapy (CCRT) of American style is currently not widely accepted. Therefore, the advantage and disadvantage of these two treatment modalities for advanced rectal cancers need be further clarified. In this project, we plan to randomly assign the patients into two groups: (1) concurrent preoperative chemoradiation therapy (CCRT) + conventional surgery group; (2) wide pelvic lymphadenectomy group. Thereafter, we plan to evaluate: (1) the anorectal function by anorectal manometry and colonic transit time using radioopaque markers; (2) the micturition function using urodynamic study; (3) the penile erection by RigiScan; and (4) the ejaculatory function by clinical interview of the patients. Moreover, the various clinicopathologic factors, including the depth of tumor invasion and the status of lymph node invasion, were recorded in detail according to the guidelines recommended by the Japanese Society of Coloproctology. Furthermore, we will evaluate the oncological results for these patients.

基于神经生理学的已有共识：交感神经支配射精功能与膀胱颈闭合，副交感神经则调控阴茎勃起与膀胱壁收缩。东西方国家间，因患者文化背景与医师培训背景存在差异，西方学界对扩大盆腔淋巴结清扫术的疗效尚存质疑；而东方国家则因标准化设施、治疗方案与人力资源匮乏，美式术前同步放化疗（concurrent preoperative chemoradiation therapy, CCRT）目前尚未得到广泛认可。因此，针对晚期直肠癌的这两种治疗方案，其优劣仍有待进一步阐明。本研究计划将患者随机分为两组：(1) 术前同步放化疗（CCRT）联合常规手术组；(2) 扩大盆腔淋巴结清扫术组。随后本研究将开展以下评估：(1) 采用肛门直肠测压法与不透射线标记物检测结肠传输时间，以评估肛肠功能；(2) 借助尿流动力学检查评估排尿功能；(3) 通过RigiScan检测阴茎勃起功能；(4) 通过患者临床访谈评估射精功能。此外，本研究将按照日本结直肠外科学会（Japanese Society of Coloproctology）推荐的指南，详细记录各类临床病理因素，包括肿瘤浸润深度与淋巴结浸润状态。同时，本研究还将评估患者的肿瘤学治疗结局。