Multicenter Study on Preservation Versus Excision of Denonvilliers Fascia in L-PANP Surgery

Inclusion criteria

• Male, 20 < age (years) < 71, informed consent;
• Pathological diagnosis of rectal adenocarcinoma;
• Tumors from anal edge 6 ~ 12 cm (measured by rigid proctoscope);
• Preoperative staging T1-4 (T1-2 for anterior rectal wall) N0-2M0 rectal cancer (AJCC- 7th);
• R0 TME surgical results is expected;
• Preoperative ECOG physical status score 0/1;
• Preoperative ASA grade I ~ III;
• Normal urinary function (Bladder residual urine<100ml), normal erection function (IIEF-5>21) and ejaculation function grading as I level.

Exclusion criteria

• Complicated with acute ileus, perforation or hemorrhage;
• Tumors with extensive invasion of surrounding tissues, TME not applicable; Imaging examination in regional integration intumescent lymph nodes (maximum diameter 3 cm or higher);
• With other malignant diseases or with other malignant disease within 5 years; With other diseases need surgery;
• A history of abdominal and pelvic major operation;
• People with severe mental illness, or cannot be evaluated due to cultural or psychological factors;
• No sexual life;
• Critical organ dysfunction, unbearable surgery;
• Unstable angina, myocardial infarction, cerebral infarction or hemorrhage within 6 months;
• Systemic corticosteroids or immunosuppressive medication history within 1 month;
• Pre-existent true incontinence or severe stress urinary incontinence.

Exit criteria:

• Confirmed as M1 during or after operation;
• Conversion to abdominoperineal resection (APR)
• Postoperatively confirmed as invading rectal intrinsic fascia, or T3 for anterior rectal wall;
• Intraoperative confirmed regional lymph node fusion conglobation cannot ensure R0 resection;
• Infiltrating major blood vessel and unresectable;
• Intraoperative finding other diseases need simultaneous surgery;
• Preoperative emergent severe complications, cannot carry out the study treatment;
• Emergency surgery is needed;
• Into this study, at any stage of the initiative exit or discontinue treatment; Prove to implement the healer violates this research plan.