Male sexual and urinary function after laparoscopic total mesorectal excision

Abstract

Background Urinary and sexual dysfunction are potential complications of rectal surgery for cancer. This study retrospectively evaluated the frequency of such complications after laparoscopic total mesorectal excision (LTME) with autonomic nerve preservation. Methods For this study, 50 men younger than 75 years who underwent radical LTME for mid and low rectal cancer were followed up for at least 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. Results Sexual desire was maintained by 55.6%, ability to engage in intercourse by 57.8%, and ability to achieve orgasm and ejaculation by 37.8% of the patients. Distance of the tumor from the anal verge and adjuvant or neoadjuvant treatments were the significant predictors of poor postoperative sexual function. Seven patients (14%) presented transitory postoperative urinary dysfunction, all of whom were medically treated. Tumor stage and distance from the anal verge were independently associated with the postoperative global International Prostatic Symptom Score (IPSS). No differences were observed in urinary quality of life. Conclusions In this series, LTME did not reproduce or improve on sexual and urinary dysfunction outcomes obtained in the best open TME series. Further trials are needed to evaluate functional outcome in rectal cancer patients.Keywords Urinary dysfunction Á Sexual dysfunction Á Quality of life Á Laparoscopy Á Total mesorectal excision Á Rectal cancer Laparoscopic total mesorectal excision (TME) for rectal cancer is technically feasible, offering acceptable complication rates and short-term oncologic outcomes comparable with those for open surgery [1][2][3][4][5][6][7][8]. However, quality of life (QoL) must not be forgotten in the quest for oncologic excellence. Postoperative urinary and sexual dysfunction resulting from inadvertent damage to the pelvic hypogastric and splanchnic nerves are recognized complications of rectal resection [9][10][11].Laparoscopic surgery, although technically demanding and associated with a long learning curve, has the advantage of clear visualization for the smallest structures, including the autonomic nerves. The use of the laparoscopic approach for the treatment of rectal cancer could therefore facilitate preservation of the pelvic autonomic nerves. Nevertheless, data on the functional outcome of laparoscopic TME are limited and controversial [12,13].This retrospective clinical study aimed to evaluate male sexual and functional outcomes in a consecutive series of patients who underwent laparoscopic surgery for lower and middle rectal cancer at our institutions. Materials and methodsMale patients with a diagnosis of cancer in the mid or distal rectum were identified from a prospective database of 850 patients who underwent laparoscopic colorectal resection. The site of rectal neoplasm was defined according to the

Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm

“…Nevertheless, anterior rectal resection and total mesorectal excision are burdened with high morbidity and mortality rates [5], including urogenital dysfunctions [1]. Transanal surgery with retractors, although less invasive, is associated with a consistent incidence of recurrence, especially for tumors of the upper and medium rectum [22][23][24][25].…”

“…In the field of malignant rectal neoplasms, radical resection, consisting of anterior resection with total mesorectal excision (TME) when feasible and abdominoperineal resection (APR) when mandatory, represents the best curative treatment. Nevertheless, these procedures are burdened with a consistent morbidity rate, including genitourinary and sexual dysfunction (30-40%) [1][2][3][4], anastomotic leakage (5-17%) [5], and long-term functional bowel disturbance [6]. Up to 40% of patients experience perineal wound complications and long-term discomfort following APR, while stoma and stoma appliance-related complications occur in up to 66%.…”

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

“…However, it is associated with significant postoperative mortality and short and long-term morbidity, including sexual and urinary dysfunction, anterior resection syndrome and stoma related complications. [135][136][137][138][139][140] In locally advanced rectal cancer, both neoadjuvant CRT and short-course radiotherapy (SCRT) induce significant tumour regression, tumour downstaging and sterilization of perirectal lymph nodes, with better local control compared to surgery alone or postoperative CRT. [141][142][143][144] A complete response on pathology (pCR) is observed in up to 30% of patients, [145] with significantly better oncologic outcomes in patients with pCR than non-responders in terms of local control, distant metastases rate and both 5-year overall and disease-free survival [145].…”

Transanal Endoscopic Microsurgery

“…Nevertheless, radical surgery is associated with high rates of genitourinary and sexual dysfunction (30-40%), anastomotic leakage (5-17%), and changes in bowel habits (frequent bowel movements, urgency, and incomplete evacuation). Abdomino perineal resection is associated with 40% of perineal wound complications, 66% of stoma complications and patient depression in 30% [26][27][28][29]. Local excision of advanced rectal cancers with curative intent remains a debatable issue.…”