Potential benefit of laparoscopic surgery for rectal cancer on postoperative male sexual function

Abstract

Aim:The aim of this retrospective study was to evaluate the incidence of male sexual dysfunction after mid to low rectal cancer surgery and to identify factors associated with postoperative erectile and ejaculatory dysfunction. Methods:The subjects were 410 consecutive male patients who underwent surgery for mid to low rectal cancer from 2009 to 2015. Two questionnaires on sexual function were administered: the International Index of Erectile Function, and an original questionnaire on ejaculatory status. Erectile and ejaculatory dysfunction were examined before and 3, 6, 12 months after surgery. In patients without preoperative dysfunction, multivariate regression analyses were performed to identify factors associated with the incidence of erectile and ejaculatory dysfunction at 12 months after surgery.Results: Of 410 patients, 234 (57%) gave complete responses to the questionnaires, of whom 108 (46%) and 155 (66%) had severe erectile dysfunction, while 115 (49%) and 168 (72%) had severe ejaculatory dysfunction before and 12 months after surgery, respectively. Of the patients who maintained sexual function preoperatively, the incidence of erectile and ejaculatory dysfunction at 12 months after surgery was 51% (64/126) and 49% (58/119), respectively. In multivariate analysis, age >60 years (P = 0.02), laparotomy (P = 0.002), and creation of a diverting ileostomy (P = 0.003) were independent factors associated with postoperative erectile dysfunction, while age >60 years (P = 0.005), laparotomy (P = 0.04), and lateral lymph node dissection (P = 0.001) were independent factors associated with postoperative ejaculatory dysfunction. Conclusion:Sexual dysfunction occurred in almost half of patients after rectal cancer surgery, and was independently associated with several factors, including laparotomy.

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“…Erectile dysfunction (ED) is a common complication that significantly affects the postoperative quality of life in patients with colorectal cancer (CRC). Despite significant advances in surgical techniques, ED may occur in approximately half of the male patients who undergo surgery for CRC [ 1 ]. It is mainly attributed to pelvic cavernous nerve injury (CNI), resulting in corporal smooth muscle fibrosis [ 2 , 3 ].…”

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“…Other obstacles to sexual function assessment include different criteria [12,26], follow-up duration [3,6], and characteristics of the study participants [39]. Limiting the participants by exclusively targeting those with a normal sexual function status preoperatively is controversial.…”

“…The IIEF5 [23] consists of five items related to erection and sexual intercourse out of the 15 items of the IIEF, and each item is rated on a five-point scale, with a total possible score of 5-25; a higher score indicates a better function. The IIEF5 and IIEF scores were calculated and evaluated longitudinally using the preoperative and postoperative (3,6 and 12 month) questionnaires. Erectile dysfunction was defined as a decrease in the IIEF5 score at 12 months postoperatively compared with the preoperative status.…”

“…Damage to the sympathetic nervous system can result in altered ejaculation, such as retrograde or no ejaculation, while parasympathetic or mixed disturbances can result in erectile dysfunction [4, 5]. In addition, the surgery type [6, 7], ostomy creation [3], and neoadjuvant chemoradiotherapy (nCRT) [6] are reported risk factors for sexual dysfunction.…”

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The primary goal of surgery for rectal cancer is to achieve a cure; however, preserving anorectal, urinary and sexual function is a significant priority for patients. Due to the close proximity of the autonomic nerves in the pelvis to the mesorectum, defaecatory, urinary and sexual dysfunction have been reported after surgical procedures for rectal cancer [1][2][3]. Male sexual dysfunction is a frequent concern.

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