Systematic review of the feasibility to spare the rectoprostatic fascia in male patients undergoing total mesorectal excision for rectal cancer

Abstract

Abstract Background The main purpose of this study was to identify feasibility to spare rectoprostatic fascia (RPF) in adult male cadavers and in adult male patients undergoing total mesorectal excision (TME) for rectal cancer. A secondary objective was to evaluate urogenital function following rectal cancer surgery and oncologic outcome. Methods Adhering to PRISMA guidelines, we performed a systematic review with a priori design to identify relevant studies using MESH terms and keywords. Research was conducted through 1st of March to 31st of July 2023 in MEDLINE, SCOPUS, Web of Science, Google Scholar and reference lists. Disagreements between individual judgments were resolved with referral to a third researcher. Results In total 1211 studies were identified out of which 17 were relevant to the main research question. Overall, 496 living individuals and 25 cadavers were included in whom RPF was identified and spared. Conclusions Despite the fact that current practice on rectal cancer surgery dictates TME to extend anterior to the RPF, based on our findings, RPF-spare TME is not only feasible but also important for preserving fair male urogenital function especially for young patients whose erectile function is a priority. Trial registration number and date of registration: CRD42020171188, February 2023