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

The main purpose of this study was to determine the feasibility of sparing the rectoprostatic fascia (RPF) in adult male cadavers and in adult male patients who underwent total mesorectal excision (TME) for rectal cancer. A secondary objective was to evaluate urogenital function following rectal cancer surgery, pathologic, and oncologic outcomes.

In accordance with PRISMA guidelines, we performed a systematic review with an a priori design to identify relevant studies via MESH terms and keywords. Research was conducted from March 1st to July 31st 2023 and was updated between September 30th to October 10th 2024 in MEDLINE, SCOPUS, the Web of Science, Google Scholar, and reference lists. Disagreements between individual judgments were resolved by referral to a third researcher.

In total, 3693 studies were identified, 22 of which were relevant to the main research question. Overall, 785 living individuals and 25 cadavers were included in whom RPF was identified and spared (498/785 patients or 63.44%). The quality of the surgical specimen was considered good in all cases. Urogenital integrity at 6 months after RPF-TME and the classic TME were compromised in 27.9% and 41% of patients, respectively. One study revealed that at 3 years, local/systemic recurrence was similar between the two groups.

Despite the fact that the current practice of rectal cancer surgery requires the TME to extend anteriorly to the RPF, RPF-sparing TME is not only a feasible and safe option but also important for preserving fair male urogenital function, especially for young patients whose erectile function is a priority.

CRD42020171188