Laparoscopic Rectal Cancer Resection With Pelvic Autonomic Nerve Preservation in Males: A Prospective Single-Center...

PANP has been applied in laparoscopic radical rectal cancer resection, significantly reducing the incidence of genitourinary dysfunction; however, it has not eliminated sexual and urinary dysfunction. Prospective trials focusing on genitourinary function as a primary outcome are rare. To confirm the protective effect on sexual and urinary function in laparoscopic radical resection of rectal cancer with pelvic autonomic nerve preservation (PANP), and explore the risk factor of postoperative sexual dysfunction.

A prospective, single-center, single-arm trial was conducted on male patients with rectal adenocarcinoma suitable for laparoscopic surgery with PANP at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Patients with normal genitourinary function were included, and the primary outcome was the change in sexual function 6 months after the operation.

Of 91 patients enrolled, 70 underwent a laparoscopic operation. Six months after the operation, 5 patients were lost to follow-up, and the IIEF-5 and IPSS scores were 22.85 ± 3.66 versus 24.10 ± 1.21 (p = 0.003) and 2.11 ± 2.06 versus 1.89 ± 1.86 (p = 0.018), respectively, compared with preoperative values. Five patients (7.69%) suffered from sexual disorders, and 2 patients (3.08%) developed moderate urinary dysfunction. The majority of the autonomic nerve system was visible and preserved intraoperatively. Quality of TME was complete in 94.29% (66/70) and partially complete in 5.71% (4/70) of patients, respectively. Positive CRM in this study was 2.86% (2/70), and positive distal resection margin was 1.43% (1/70). The mean postoperative hospital stay was 7.80 ± 2.44 days. Surgical procedure, distance of tumor to AV, clinical TNM stage, nCRT, stoma, and completeness of the autonomic nervous system were risk factors of postoperative sexual dysfunction in univariate analysis; however, none of them was an independent risk factor in multivariate analysis.

PANP in laparoscopic radical rectal resection effectively preserves sexual and urinary function without compromising oncological outcomes. It is safe and feasible in high-flow centers and for experienced surgeons.