FTP3.3 Pelvic intraoperative neuromonitoring during anterior or abdominoperineal resections: a critical appraisal of published studies by meta-analysis

Abstract Objective Anorectal, urinary and sexual dysfunction following rectal resections (RR) is a clinical problem influencing the health related quality of life significantly. The objective of this review is to evaluate the role of intraoperative neuromonitoring (pIONM) to prevent pelvic nerve damage leading to urogenital dysfunction in patients undergoing RR. Materials and methods All types of comparative studies reporting the role of pIONM to avoid pelvic nerve damage leading to urogenital dysfunction in patients undergoing RR were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results The search of medical databases yielded 6 comparative studies (one randomised trial and 3 retrospective and 2 prospective studies) on 489 patients undergoing RR. In the random effects model analysis, pIONM failed to reduce the incidence of erectile dysfunction (p = 0.27), urinary dysfunction (p = 0.78), and sexual dysfunction (p = 0.18). However, the risk of anorectal dysfunction [standardised mean difference -0.57, 95%, CI (-0.81, -0.34), Z = 4.85, P=0.00001] reduced significantly by use of pIONM during open/laparoscopic or robotic RR. There was no heterogeneity (Tau2 = 0.0; Chi2 = 1.48, df = 3; (p < 0.48; I2 = 0 %) among included studies. Conclusion pIONM may reduce the risk of anorectal dysfunction following RR but the outcomes related to urinary and sexual dysfunction seem to be unchanged. However, due to paucity of the randomised trials, these findings should be taken cautiously.