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Published in:

01-02-2009

Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer

Authors: Oktar Asoglu, Tugba Matlim, Hasan Karanlik, Murat Atar, Mahmut Muslumanoglu, Yersu Kapran, Abdullah Igci, Vahit Ozmen, Mustafa Kecer, Mesut Parlak

Published in: Surgical Endoscopy | Issue 2/2009

Abstract

Background

Bladder and sexual dysfunction are well-documented complications of rectal cancer surgery. This study aimed to determine whether laparoscopy can improve the outcome of these dysfunctions or not.

Methods

The study included 63 of the 116 patients who underwent surgery for rectal cancer between 2002 and 2006. Bladder and male sexual function were studied by means of a questionnaire on the basis of the International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement and uroflowmetry. Postoperative functions were compared with the preoperative data to detect subjective functional deterioration. Outcomes were compared between patients who underwent open (group 1, n = 29) and laparoscopic (group 2, n = 34) total mesorectal excision.

Results

Only minor disturbances of bladder function were reported for one patient (3%) in group 1 and three patients (9%) in group 2 (p > 0.05). Impotency after surgery was experienced by 6 of 17 preoperatively sexually active males (29%) in group 1 and 1 of 18 males (5%) in group 2 (p = 0.04). Similarly, 5 of 10 women (50 %) in group 1 and 1 of 14 women (7%) in group 2 felt that their overall level of sexual function had decreased as a result of surgery (p = 0.03).

Conclusions

Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery.

Chang PL, Fan HA (1983) Urodynamic studies before and/or after abdominoperineal resection of the rectum for carcinoma. J Urol 130:948–951PubMed

Kinn AC, Ohman U (1986) Bladder and sexual function after surgery for rectal cancer. Dis Colon Rectum 29:43–48PubMedCrossRef

Santangelo ML, Romano G, Sassaroli C (1987) Sexual function after resection for rectal cancer. Am J Surg 154:502–504PubMedCrossRef

Fazio VW, Fletcher J, Montague D (1980) Prospective study of the effect of resection of the rectum on male sexual function. World J Surg 4:149–152PubMedCrossRef

Heald RJ (1988) The ‘holy Plane’: of rectal surgery. J R Soc Med 81:503–508PubMed

Pocard M, Zinzindohoue F, Haab F, Caplin S, Parc R, Tiret E (2002) A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer. Surgery 131:368–372PubMedCrossRef

Masui H, Ike H, Yamaguchi S, Oki S, Shimada H (1996) Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum 39:1140–1145PubMedCrossRef

Maas CP, Moriya Y, Steup WH, Kiebert GM, Kranenbarg WM, van de Velde CJ (1998) Radical and nerve-preserving surgery for rectal cancer in The Netherlands: a prospective study on morbidity and functional outcome. Br J Surg 85:92–97PubMedCrossRef

Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri LM (2000) Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 87:206–210PubMedCrossRef

10.

Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182:495–502PubMed

11.

Enker WE, Havenga K, Polyak T, Thaler H, Cranor M (1997) Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer. World J Surg 21:715–720PubMedCrossRef

12.

Kim NK, Aahn TW, Park JK, Lee KY, Lee WH, Sohn SK, Min JS (2002) Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer. Dis Colon Rectum 45:1178–1185PubMedCrossRef

13.

Pikarsky AJ, Rosenthal R, Weiss EG, Wexner SD (2002) Laparoscopic total mesorectal excision. Surg Endosc 16:558–562PubMedCrossRef

14.

Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215PubMedCrossRef

15.

Morino M, Allaix ME, Giraudo G, Corno F, Garrone C (2005) Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 19:1460–1467PubMedCrossRef

16.

Lezoche E, Guerrieri M, De Sanctis A, Campagnacci R, Baldarelli M, Lezoche G, Paganini AM (2006) Long-term results of laparoscopic versus open colorectal resections for cancer in 235 patients with a minimum follow-up of 5 years. Surg Endosc 20:546–553PubMedCrossRef

17.

Lelong B, Bege T, Esterni B, Guiramand J, Turrini O, Moutardier V, Magnin V, Monges G, Pernoud N, Blache JL, Giovannini M, Delpero JR (2007) Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 50:176–183PubMedCrossRef

18.

Mebust W, Roizo R, Schroeder F, Villers A (1991) Correlation between pathology, clinical symptoms and course of the disease. In: Cockett AT, Aso V, Chatelain C et al (eds) Proceeding of the international consultation on benign prostatic hyperplasia. WHO, Geneva, pp 51–62

19.

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830PubMedCrossRef

20.

Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ (2005) Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg 92:1124–1132PubMedCrossRef

21.

Keating JP (2004) Sexual function after rectal excision. ANZ J Surg 74:248–259PubMedCrossRef

22.

Chang PL, Fan HA (1983) Urodynamic studies before and/or after abdominoperineal resection of the rectum for carcinoma. J Urol 130:948–951PubMed

23.

Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89:1551–1556PubMedCrossRef

24.

Cosimelli M, Mannella E, Giannarelli D, Casaldi V, Wappner G, Cavaliere F, Consolo S, Appetecchia M, Cavaliere R (1994) Nerve-sparing surgery in 302 resectable rectosigmoid cancer patients: genitourinary morbidity and 10-year survival. Dis Colon Rectum 37(Suppl):S42–S46PubMedCrossRef

25.

Enker WE (1992) Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127:1396–1402PubMed

26.

Lindsey I, Guy RJ, Warren BF, Mortensen NJ (2000) Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 87:1288–1299PubMedCrossRef

27.

Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K (2006) Operating behind Denonvilliers’ fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum 49:1024–1032PubMedCrossRef

28.

Marijnen CA, van de Velde CJ, Putter H, van den Brink M, Maas CP, Martijn H, Rutten HJ, Wiggers T, Kranenbarg EK, Leer JW, Stiggelbout AM (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23:1847–1858PubMedCrossRef

Title: Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer
Authors: Oktar Asoglu
Tugba Matlim
Hasan Karanlik
Murat Atar
Mahmut Muslumanoglu
Yersu Kapran
Abdullah Igci
Vahit Ozmen
Mustafa Kecer
Mesut Parlak
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 2/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-9870-7

At a glance: The STEP trials

Springer Medicine

Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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