Risk factors for sexual dysfunction after rectal cancer surgery in 948 consecutive patients: A prospective cohort study

Abstract

Background: Sexual dysfunctions seriously affect the quality of life of patients. The aim of this study was to identify the risk factors for sexual dysfunction after rectal cancer surgery. Methods: A total of 948 consecutive patients undergoing rectal cancer radical resection were included between January 2012 and August 2019. The sexual functions were evaluated by the 5-item version of the International Index of Erectile Function (IIEF-5) in men and Index of Female Sexual Function (IFSF) in women at 12 months postoperatively. Results: Postoperative sexual dysfunction was observed in 228 patients with rectal cancer (24.05%), which included 150 cases in male patients (25.0%) and 78 cases in female patients (22.5%). A multivariate logistic regression analysis results showed that age 45 years old (OR ¼ 1.72, p ¼ 0.001), tumor below the peritoneal reflection (OR ¼ 1.64, p ¼ 0.005), receiving preoperative radiotherapy (OR ¼ 4.12, p < 0.001) and undergoing abdominoperineal resection (APR), intersphincteric resection (ISR) and Hartmann surgery (OR ¼ 2.43, p < 0.001) were the independent risk factors of sexual dysfunction for patients with rectal cancer. Conclusion: Age 45 years old, tumors below the peritoneal reflection, receiving preoperative radiotherapy, and undergoing APR, ISR and Hartmann surgery were the independent risk factors of sexual dysfunction. Patients should be informed about the sexual dysfunctions in the pre-operative consultations. More attention should be paid to intraoperative pelvic autonomic nerve preservation on rectal cancer patients with these risk factors for clinic surgeons.

Identification of Risk Factors for Sexual Dysfunction after Multimodal Therapy of Locally Advanced Rectal Cancer and Their Impact on Quality of Life: A Single-Center Trial

“…Tumor below 6 cm from the anal verge was shown to be another risk factor for poor sexual outcome in this study in the univariate- (<6 cm vs. ≥6 cm: OR: 4.43, 95%CI: 1.44–13.67, p = 0.01) as well as in the multivariate analysis (<6 cm vs. ≥6 cm: OR: 4.64, 95%CI: 1.18–18.29, p = 0.03) which is consistent with previously published studies [ 7 , 25 ]. The risk for pelvic nerve injuries is reported to increase in cancer localization under the peritoneal reflection [ 25 ].…”

“…Moreover, vaginitis, vaginal atrophy and vaginal stenosis are described after radiotherapy of pelvic cancers [ 24 ]. The cause for radiotherapy-associated problems is multifactorial and involves vascular and genital tissue fibrosis, neurological damage, vaginal narrowing and loss of elasticity [ 7 ]. In addition, nerve injury and postoperative scarring around the vaginal region may contribute to dissatisfaction or avoidance of sexual intercourse [ 25 ].…”

“…In the previous literature, different cutoff values of age were used to evaluate SD after rectal cancer treatment. SD is reported to increase with the age [ 7 , 28 , 29 , 30 ], which may be due to an increased rate of comorbidities on the one hand and reduced sexual desire in elderly patients on the other hand. Schmidt et al [ 31 ] were able to show that younger rectal cancer patients suffer more from the pressure of a possible SD than older patients, thus, quality of life is more negatively affected in those patients.…”

“…Limited view and narrow pelvis in this area especially in male patients may lead to increased rates of nerve damage. The use of advanced sphincter-sparing techniques, including ISR and coloanal anastomosis may cause further irritation of sexual function due to either postoperative fibrosis or scarring alteration of the perineum and distal vaginal region [ 7 ].…”

“…However, SD after rectal cancer surgery is common, inadequately discussed, multifactorial and often untreated [ 6 ]. It is well known that postoperative SD is caused by nerve damage or vascular injury of the vasa nervosa during surgery and occurs between 11% and 55% of patients [ 7 ]. Furthermore, pelvic radiotherapy induces an inflammatory response and vascular and neurological damage with genital fibrosis in women [ 8 ].…”