Functional outcomes following laparoscopic and open rectal resection for cancer

A best evidence topic was written according to a structured protocol. The question addressed whether laparoscopic approach confers a difference in functional outcome compared to conventional open resectional surgery for rectal cancer. 246 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and key results of these papers are tabulated. Of these five studies, none showed any difference in post-operative urinary function between patients undergoing laparoscopic or open surgery. The two randomised studies reported either a trend or a significant difference in favour of open surgery for sexual outcome in men. Three more recent, case-control studies showed differences in favour of laparoscopic surgery for sexual function in men. We conclude that there is no evidence to suggest that laparoscopic approach makes any difference to post-operative urinary function. The data relating to sexual function in men is contradictory, and as none of the studies available have generated high level evidence and further trials are required to clarify whether laparoscopic approach confers an advantage or disadvantage in terms of sexual function for men post-operatively. In terms of sexual function in women, the available data is far too scarce to satisfactorily determine whether laparoscopy is superior to open surgery.