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Prospective study of sexual dysfunction in men with rectal cancer: feasibility and results of nerve sparing surgery
Valerio Celentano1, Giovanni Fabbrocile, Gaetano Luglio
1Department of General, Oncologic and Video-Assisted Surgery, University Federico II, Naples, Italy. valeriocelentano@yahoo.it
Purpose:
Rectal cancer surgery is impaired by a high rate of postoperative sexual dysfunction cause of frequent nerve injuries. The aim of this study was to prospectively evaluate sexual function in a group of male patients after total mesorectal excision (TME) for rectal cancer, using an autonomic nerve sparing technique.
Methods:
All patients underwent autonomic nerve preserving TME. Sexual function was assessed using the International Index of Erectile Function standardized questionnaire. All patients were studied preoperatively and at 3, 6, 12, 18, and 24 months after surgery.
Results:
Fifty-one patients with adenocarcinoma of the rectum were enrolled; after excluding 16 patients not sexually active, nine with T4 stage disease and six with metastatic disease, 20 patients were prospectively evaluated. The preoperative erectile function (EF) domain score of the International Index of Erectile Function was 24.3 (±4.1). The score of the EF domain was 17.6 (±7.5), 19.l9 (±7.2), 20.3 (±7.4), 20.5 (±7.4), and 20.6 (±7.4) at 3, 6, 12, 18, and 24 months after surgery. In the group of patients in which there were no macroscopic damages to the nerves, only two out of 15 (13.3%) developed erectile dysfunction. All five patients in whom incomplete pelvic nerve preservation was necessary developed erectile dysfunction.
Conclusion:
Our data show that nerve sparing technique can reduce the incidence of sexual dysfunction. Unfortunately, the technique is not applicable in every patient. Indications and techniques of autonomic nerve preservation are not standardized. Controlled trials with long-term follow-up seem to be necessary.
Insights
Nerve sparing surgery for rectal cancer can reduce sexual dysfunction. However, this technique is not always possible, and standardization is needed for better outcomes.
Area of Science:
- Oncology
- Urology
- Surgical Innovation
Background:
- Rectal cancer surgery, particularly total mesorectal excision (TME), is associated with a high incidence of postoperative sexual dysfunction due to autonomic nerve damage.
- Preserving autonomic nerves during TME is crucial for maintaining sexual function in male patients.
Purpose of the Study:
- To prospectively evaluate sexual function in male patients undergoing nerve-sparing TME for rectal cancer.
- To assess the impact of autonomic nerve preservation techniques on erectile function post-surgery.
Main Methods:
- Prospective evaluation of 20 male patients with rectal adenocarcinoma undergoing autonomic nerve-preserving TME.
- Sexual function assessed using the International Index of Erectile Function (IIEF) questionnaire preoperatively and at 3, 6, 12, 18, and 24 months post-surgery.
Main Results:
- The mean preoperative Erectile Function (EF) domain score was 24.3. Postoperative EF scores showed improvement over 24 months, reaching 20.6.
- Only 13.3% of patients with no macroscopic nerve damage developed erectile dysfunction.
- All patients requiring incomplete pelvic nerve preservation experienced erectile dysfunction.
Conclusions:
- Autonomic nerve-sparing techniques in TME can significantly reduce the incidence of sexual dysfunction after rectal cancer surgery.
- The applicability of nerve-sparing TME is limited in certain cases, highlighting the need for standardized indications and techniques.
- Further controlled trials with long-term follow-up are necessary to optimize nerve preservation strategies in rectal cancer surgery.
