Impact of robot-assisted surgery on postoperative sexual function in younger male rectal cancer patients.

Abstract

63 Background: The purpose of this study was to investigate postoperative sexual dysfunction in male rectal cancer patients aged ≤60 years. Methods: This was a subgroup analysis of the multicenter prospective observational study, the LANDMARC study (“Postoperative Sexual Dysfunction after Laparoscopic Surgery for Rectal Cancer”). Male patients who underwent laparoscopic surgery (Lap group), robot-assisted surgery (Ro group), or transanal excision were included. Sexual function was assessed using the Erection Hardness Score (EHS) and the ejaculation function questionnaire (EORTC QLQ-CR38). At 3, 6, and 12 months postoperatively, the incidence of erectile dysfunction (ErD), ejaculatory dysfunction (EjD), potency impairment (defined as a preoperative EHS ≥3 decreasing to ≤2 postoperatively), and overall sexual dysfunction (SD = ErD + EjD) was compared between the Lap and Ro groups. Results: Male patients ≤60 years were analyzed: Lap group (n=76), Ro group (n=103). No significant differences were observed between groups in ASA-PS, tumor location, T factor, N factor, preoperative treatment rate, operative procedures, or rate of lateral lymph node dissection. ErD incidence: 3 months (44.7% vs 35.0%, p=0.22), 6 months (35.0% vs 28.9%, p=0.42), 12 months (33.8% vs 23.5%, p=0.17). EjD incidence: 3 months (53.3% vs 31.3%, p=0.03), 6 months (41.7% vs 21.1%, p=0.02), 12 months (44.9% vs 17.4%, p=0.002). Potency impairment: 3 months (22.4% vs 13.5%, p=0.15), 6 months (24.3% vs 13.5%, p=0.10), 12 months (22.9% vs 8.8%, p=0.02). SD incidence: 3 months (57.0% vs 43.3%, p=0.07), 6 months (47.5% vs 37.5%, p=0.17), 12 months (50.0% vs 26.3%, p=0.002). Multivariate analysis for sexual dysfunction (ErD + EjD) at 12 months postoperatively identified laparoscopic surgery as an independent risk factor (HR 2.34; 95% CI 1.17–4.65; p=0.01). Conclusions: Robot-assisted surgery appears to be beneficial for sexual function preservation in male rectal cancer patients aged ≤60 years. Clinical trial information: UMIN000037367 .