Top

Published in:

01-12-2009

Prospective evaluation of sexual function after open and laparoscopic surgery for rectal cancer

Authors: Paraskevas Stamopoulos, George E. Theodoropoulos, Joanna Papailiou, Dimitris Savidis, Christina Golemati, Konstantinos Bramis, Sotirios-George Panoussopoulos, Emmanouil Leandros

Published in: Surgical Endoscopy | Issue 12/2009

Abstract

Background

Sexual function may be harmed after treatment for rectal cancer. This study aimed to evaluate prospectively the incidence of sexual dysfunction after rectal cancer treatment and to compare the effects of laparoscopic and traditional open approaches in terms of postoperative sexual function.

Methods

Baseline and 3-, 6-, and 12-month assessments of sexual dysfunction using the International Index of Erectile Function (IIEF) and its specific domains prospectively took place for 56 patients who underwent rectal cancer surgery (38 open vs. 18 laparoscopic procedures, 38 low anterior vs. 18 abdominoperineal resections). The preliminary results are presented.

Results

The average total IIEF and isolated IIEF response domain scores were significantly decreased after surgery (p < 0.01) except for the intercourse satisfaction and overall satisfaction scores at 12 months. An improvement in IIEF scores was observed between the 3- and 6-month assessment points (p < 0.01) except for the erectile function and orgasmic function scores. No significant differences were observed between the open and laparoscopic groups in the total IIEF and domain scores preoperatively and at the 3- and 6-month assessment points. The rates of sexual dysfunction did not differ significantly preoperatively or at 3 months postoperatively when open and laparoscopic procedures were compared, although there was a trend in favor of laparoscopic surgery at 6 months (p = 0.076). The baseline IIEF score and the baseline, 3-, and 6-month sexual desire scores were better (p = 0.035, 0.004, 0.017, and 0.061, respectively) in the low anterior resection group than in the abdominoperineal resection group.

Conclusions

Rectal cancer resections were postoperatively associated with a significant reduction in IIEF scores and high rates of sexual dysfunction at 3 and 6 months. The IIEF and domain scores at different assessment points were comparable between the laparoscopic and open surgery groups. Extending the monitoring period and adding more patients in this ongoing prospective study will further elucidate postoperative sexual dysfunction after rectal cancer surgery.

Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899CrossRefPubMed

ASCO (1996) Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. J Clin Oncol 14:671–679

Cammilleri-Brennan J, Steele RJC (1998) Quality of life after treatment for rectal cancer. Br J Surg 85:1036–1043CrossRef

Hendren SK, O’Connor IB, Liu M, Asano T, Cohenn Z, Swallow JC, MacRae MH, Gryfe R, McLeod SR (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242:212–223CrossRefPubMed

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 29:43–48CrossRefPubMed

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

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

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

10.

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 21:715–720CrossRefPubMed

11.

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 39:1140–1145CrossRefPubMed

12.

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 85:92–97CrossRefPubMed

13.

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 87:206–210CrossRefPubMed

14.

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 45:1178–1185CrossRefPubMed

15.

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 92:1124–1132CrossRefPubMed

16.

Cöl C, Hasdemir O, Yalçin E, Yandakçi K, Tunç G, Kuçukpinar T (2006) Sexual dysfunction after curative radical resection of rectal cancer in men: the role of extended systematic lymph-node dissection. Med Sci Monit 12:CR70–CR74PubMed

17.

Asoglu O, Matlim T, Karanlik H, Atar M, Muslumanoglu M, Kapran Y, Igci A, Ozmen V, Kecer M, Parlak M (2008) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc [Epub ahead of print]

18.

Breukink SO, van Driel MF, Pierie JP, Dobbins C, Wiggers T, Meijerink WJ (2008) Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision. Int J Colorectal Dis [Epub ahead of print]

19.

Lacy AM, García-Valdecasas JC, Piqué JM, Delgado S, Campo E, Bordas JM, Taurá P, Grande L, Fuster J, Pacheco JL et al (1995) Short-term outcome analysis of a randomized study comparing laparoscopic vs. open colectomy for colon cancer. Surg Endosc 9:1101–1105PubMed

20.

Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs. open colectomy for colon cancer: a randomized trial. JAMA 287:321–328CrossRefPubMed

21.

Breukink SO, Pierie JP, Grond AJ, Hoff C, Wiggers T, Meijerink WJ (2005) Laparoscopic versus open total mesorectal excision: a case-control study. Int J Colorectal Dis 20:428–433CrossRefPubMed

22.

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 89:1551–1556CrossRefPubMed

23.

Yang L, Yu YY, Zhou ZG, Li Y, Xu B, Song JM, Liu HY, Jiang X (2007) Quality-of-life outcomes following laparoscopic total mesorectal excision for low rectal cancers: a clinical control study. Eur J Surg Oncol 33:575–579CrossRefPubMed

24.

Tsang WW, Chung CC, Kwok SY, Li MK (2006) Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results. Ann Surg 243:353–358CrossRefPubMed

25.

Liang JT, Lai HS, Lee PH (2007) Laparoscopic pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer after chemoradiation therapy. Ann Surg Oncol 14:1285–1287CrossRefPubMed

26.

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 49:822–830CrossRefPubMed

27.

Hojo K, Vernava AMIII, Sugihara K, Katumata K (1991) Preservation of urine voiding and sexual functions after rectal cancer surgery. Dis Colon Rectum 34:532–539CrossRefPubMed

28.

Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMed

29.

Havenga K, Maas CP, DeRuiter MC, Welvaart K, Trimbos JB (2000) Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer. Semin Surg Oncol 18:235–243CrossRefPubMed

30.

Wu CJ, Hsieh JT, Lin JS, Hwang TI, Jiann BP, Huang ST, Wang CJ, Lee SS, Chiang HS, Chen KK, Lin HD (2007) Comparison of prevalence between self-reported erectile dysfunction and erectile dysfunction as defined by five-item International Index of Erectile Function in Taiwanese men older than 40 years. Urology 69:743–747CrossRefPubMed

31.

Canadian Male Sexual Health Council (2004) Prevalence of erectile dysfunction. Canadian Male Sexual Health Council, Toronto, ON, Canada

32.

Moriya Y, Hojo K, Sawada T, Koyama Y (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32:307–315CrossRefPubMed

33.

Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289CrossRefPubMed

34.

Breukink SO, van der Zaag-Loonen HJ, Bouma EM, Pierie JP, Hoff C, Wiggers T, Meijerink WJ (2007) Prospective evaluation of quality of life and sexual functioning after laparoscopic total mesorectal excision. Dis Colon Rectum 50:147–155CrossRefPubMed

35.

Schmidt CE, Bestmann B, Küchler T, Longo WE, Kremer B (2005) Prospective evaluation of quality of life of patients receiving either abdominoperineal resection or sphincter-preserving procedure for rectal cancer. Ann Surg Oncol 12:117–123CrossRefPubMed

36.

Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238:203–213PubMed

37.

Zippe CD, Jhaveri FM, Klein EA, Kedia S, Pasqualotto FF, Kedia A, Agarwal A, Montague DK, Lakin MM (2000) Role of Viagra after radical prostatectomy. Urology 55:241–245CrossRefPubMed

Title: Prospective evaluation of sexual function after open and laparoscopic surgery for rectal cancer
Authors: Paraskevas Stamopoulos
George E. Theodoropoulos
Joanna Papailiou
Dimitris Savidis
Christina Golemati
Konstantinos Bramis
Sotirios-George Panoussopoulos
Emmanouil Leandros
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 12/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0507-2

At a glance: The STEP trials

Springer Medicine

Prospective evaluation of sexual function after open and laparoscopic surgery for rectal cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2009

Esophageal dilation after laparoscopic adjustable gastric banding: a more systematic approach is needed

Preclinical trial of a modified gastroscope that performs a true anterior fundoplication for the endoluminal treatment of gastroesophageal reflux disease

Use of double-balloon enteroscopy in the management of patients with Crohn’s disease: feasibility and diagnostic yield in a high-volume centre for inflammatory bowel disease

Is there a role for endoscopic ultrasonography in evaluation of the left liver in colorectal liver metastasis patients selected for right hepatectomy

News and notices

Minimally invasive Ivor–Lewis esophagogastrectomy for gastric cardia cancer