Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer

Abstract

Background\ud Laparoscopic total mesorectal excision (LapTME) is a validated technique for the treatment of rectal cancer. However, the ergonomic limitations of pure laparoscopy could lead to high conversion rates and a high rate of autonomic disorders. For these reasons the robot-assisted TME (RobTME) has been proposed to overcome the limitations of LapTME. The aim of this study is to compare surgical outcomes, medium-term oncologic results, and postoperative autonomic function of LapTME versus RobTME, in a single surgeon experience.\ud \ud Patients and Methods\ud The first 26 LapTME were compared with the first 26 RobTME performed by a single surgeon between January 2009 and May 2013. Perioperative outcomes were prospectively collected and compared. The impact of minimally invasive TME on autonomic function and quality of life (QOL) was analyzed with the ICIQ-FLUTS and the ICIQ-MLUTS (International Consultation on Incontinence–Male/Female Lower Urinary Tract Symptoms) and IIEF (International Index of Erectile Function)/FSFI (Female Sexual Function Index) questionnaires. Pathological aspects and oncological outcomes were also collected. \ud \ud Results\ud Of the 26 LapTME, 22 were anterior resections (ARR), 2 intersphincteric resections (ISR), and 2 abdominoperineal resections (APR), while of the 26 RobTME, 17 were ARR, 5 ISR, and 4 APR. Mean operative time was significantly higher (p<0.001) while conversion rate to hand-assisted or open surgery was significantly lower in the robTME group (p<0.05).\ud There were no significant differences in sexual and urinary scores between the two groups before surgery and at 1 year after surgery. There were no differences in 3 year overall survival, disease free survival, and recurrence rate as well as the other parameters analysed.\ud \ud Conclusion\ud RobTME is a safe and effective technique and the results compare favourably to the results obtained with laparoscopic procedures. It seems a promising alternative to preserve autonomic function and results in a low conversion rate even when used for more high risk procedures such as ISR or APR

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

“…The characteristics of all the original studies reporting either urinary or sexual outcomes are outlined in Tables 1 and 2. Of the 15 studies that met the inclusion criteria, 14 were cohort studies[5,6,9,18,30-39] and one a randomised control trial[40]. Nine of the cohort studies were comparing robotic rectal cancer surgery to either laparoscopic[9,30-33,35,38,40] or open[18] rectal cancer surgery.…”

“…Out of the 15 studies only six[5,6,9,18,30,31] were specific to urogenital outcomes; the rest reported urogenital outcomes amongst a multitude of outcomes examined in those studies.…”

“…Functional questionnaire scores were used in ten[5,6,9,18,30-33,36,37] of these studies to access the urological and sexual function of patients. These questionnaires are validated tools that have been used in a multitude of previous studies to access urinary and sexual function in males and females[41-45].…”

“…Female sexual function was assessed in three studies[6,30,37] via the Female Sexual Function Index (FSFI)[43]. This is a validated questionnaire that is in many ways the female version of the IIEF questionnaire.…”

“…It was unclear across several of the studies[6,18,30,32] how many patients were sexually inactive pre-operatively and whether they were included in the analysis. Adding sexually inactive patients in the analysis will result in skewing of the data and it is therefore important to report how many patients were sexually inactive and whether they were included in the analysis or not.…”