To explore the application value of neural monitoring technology in assisting the identification and protection of pelvic autonomic nerves (PAN) and Denonvilliers’ fascia during total mesorectal excision (TME) for male patients with middle and low rectal cancer, and to re-examine the relevant anatomical structures.

A retrospective study was conducted. A total of 78 male patients with middle and low rectal cancer who underwent TME from October 2021 to December 2022 were selected as the observation group (intraoperative pelvic autonomic nerve monitoring was performed). Meanwhile, 80 patients who underwent TME during the same period were included as the control group (intraoperative PAN protection was conducted without neural monitoring). SPSS 27.0 software was used for data analysis. Measurement data conforming to a normal distribution were expressed as (mean±standard deviation). Independent samples t test was used for inter-group comparison, and paired samples t test was used for comparison of data at different time points within the same group. Categorical data were analyzed using the χ² test. P<0.05 was considered statistically significant.

After tumor resection, there were no statistically significant differences in the potential changes of effector organs such as the prostate, seminal vesicles, bladder, and internal/external anal sphincters compared with those before tumor resection (P>0.05). At 6 months postoperatively, the International Prostate Symptom Score (IPSS) of patients in both groups was higher than that before surgery, and the International Index of Erectile Function-5 (IIEF-5) score was lower than that before surgery. Moreover, the IPSS score of the observation group was lower than that of the control group, and the IIEF-5 score was higher than that of the control group, with statistically significant differences (P<0.05). At 12 months postoperatively, the IPSS score of the control group was still higher than that before surgery, and the IIEF-5 score was still lower than that before surgery (P<0.05); however, there were no statistically significant differences between the above scores of the observation group and those before surgery (P>0.05). Additionally, the IPSS score of the observation group was lower than that of the control group, and the IIEF-5 score was higher than that of the control group (P<0.05). There was a statistically significant difference in the total incidence of postoperative complications between the two groups (P<0.05).

Implementing pelvic autonomic nerve monitoring during TME for male patients with middle and low rectal cancer can accurately identify and preserve PAN and their branches during surgery, reduce PAN injury to ensure the integrity of their functions, and improve patients’ postoperative urogenital function. Meanwhile, correct identification of Denonvilliers’ fascia during surgery and mastery of its anatomical techniques are helpful for maintaining the correct surgical anatomical plane, better protecting PAN, thereby further improving patients’ prognosis and promoting the standardized implementation of TME surgery.