Preservation versus resection of Denonvilliers’ fascia in total mesorectal excision for male rectal cancer: follow-up analysis of the randomized PUF-01 trial

Jiafeng Fang, Bo Wei, Zongheng Zheng, Jian’an Xiao, Fanghai Han, Meijin Huang, Qingwen Xu, Xiaozhong Wang, Chuyuan Hong, Gongping Wang, Yongle Ju, Guoqiang Su, Haijun Deng, Jinxin Zhang, Jun Li, Xiaofeng Yang, Tufeng Chen, Yong Huang, Jianglong Huang, Jianpei Liu and Hongbo Wei ()
Additional contact information
Jiafeng Fang: Sun Yat-sen University
Bo Wei: Sun Yat-sen University
Zongheng Zheng: Sun Yat-sen University
Jian’an Xiao: Henan University of Science and Technology
Fanghai Han: Sun Yat-sen University
Meijin Huang: The Sixth Affiliated Hospital, Sun Yat-sen University
Qingwen Xu: Affiliated Hospital of Guangdong Medical University
Xiaozhong Wang: Shantou Central Hospital
Chuyuan Hong: Guangzhou Medical University
Gongping Wang: Henan University of Science and Technology
Yongle Ju: Shunde Hospital of Southern Medical University
Guoqiang Su: Xiamen University
Haijun Deng: Nanfang Hospital of Southern Medical University
Jinxin Zhang: Sun Yat-sen University
Jun Li: Sun Yat-sen University
Xiaofeng Yang: Sun Yat-sen University
Tufeng Chen: Sun Yat-sen University
Yong Huang: Sun Yat-sen University
Jianglong Huang: Sun Yat-sen University
Jianpei Liu: Sun Yat-sen University
Hongbo Wei: Sun Yat-sen University

Nature Communications, 2023, vol. 14, issue 1, 1-9

Abstract: Abstract Traditional total mesorectal excision (TME) for rectal cancer requires partial resection of Denonvilliers’ fascia (DVF), which leads to injury of pelvic autonomic nerve and postoperative urogenital dysfunction. It is still unclear whether entire preservation of DVF has better urogenital function and comparable oncological outcomes. We conducted a randomized clinical trial to investigate the superiority of DVF preservation over resection (NCT02435758). A total of 262 eligible male patients were randomized to Laparoscopic TME with DVF preservation (L-DVF-P group) or resection procedures (L-DVF-R group), 242 of which completed the study, including 122 cases of L-DVF-P and 120 cases of L-DVF-R. The initial analysis of the primary outcomes of urogenital function has previously been reported. Here, the updated analysis and secondary outcomes including 3-year survival (OS), 3-year disease-free survival (DFS), and recurrence rate between the two groups are reported for the modified intention-to-treat analysis, revealing no significant difference. In conclusion, L-DVF-P reveals better postoperative urogenital function and comparable oncological outcomes for male rectal cancer patients.

Date: 2023
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DOI: 10.1038/s41467-023-42367-3

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