Objectives: To evaluate short-term effects of low anterior resection using either open or laparoscopic approach on erectile function (EF) and sexual performance of rectal cancer patients.
Patients & Methods: The study included 60 male patients with mean age of 57.9±5.6 years; 45 had T0 tumors, while 15 patients had T1 tumors and 51 patients had N0 and 9 patients had N1 nodal involvement. All patients had low anterior rectal resection (RR) according to the standard total mesorectal excision (TME) with identification of the hypogastric and autonomic nerves using either laparoscopic (Lap RR) or open (Open RR) approach. All patients underwent evaluation of EF using the International Index of Erectile Function (IIEF-5) and sexual function and performance using the Brief Male Sexual Function Inventory (BMSFI) preoperatively and at 6 postoperative (PO) months.
Results: Mean operative time was significantly longer in Lap compared to open RR. Mean intraoperative blood loss and need for blood transfusion was significantly lower in Lap group and time till 1st flatus passage, 1st oral fluid and solid food intake and PO hospital stay were significantly shorter in Lap RR compared to Open RR. Eight patients (13.3%) had wound related complications with significant difference in favor of Lap group. Postoperative IIEF-5 scoring of total patients showed deterioration of EF manifested as significantly lower frequency of patients had PO normal EF or even mild erectile dysfunction (ED) compared to preoperative scoring with increased frequency of patients had PO moderate and severe ED. Open procedure had more deleterious effect on EF manifested as significantly lower frequency of patients had PO normal EF or mild ED compared to preoperative scoring, while the difference was non-significant in Lap group. All patients showed deterioration of their sexual performance with significant difference compared to their preoperative score. However, patients had Lap RR showed significantly higher PO BMSFI scores compared those had open RR.
Conclusion: Laparoscopic RR provided several operative and postoperative advantages over open RR. Both procedures showed deleterious effect on erectile and sexual functions; however the effect was more pronounced with open RR.
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