TITLE:
Evaluation of Male Sexual Dysfunction Associated with Laparoscopic versus Open Resection in Rectal Cancer in Different Age Groups
AUTHORS:
Haytham Gareer, Waheed Yousry Gareer, Alaadin Hussien
KEYWORDS:
Rectal Cancer, Laparoscopic TME, Open TME, Male Sexual Dysfunction
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.9,
September
9,
2019
ABSTRACT: Background and goals Sexual dysfunction is a well-documented complication of rectal cancer
surgery, with a reported incidence of 18% - 59%. The objective of this study is
to evaluate the incidence of sexual dysfunction (SD) in males after radical
resection for rectal cancer and to compare the outcome of open versus
laparoscopic rectal resection for different age groups. Patients and methods This prospective randomized study assessed outcomes in male
patients that underwent rectal resection for rectal cancer from January 2012
until March 2015 at two large tertiary hospitals in Cairo, Egypt. The
patients were randomly allocated into two groups (laparoscopic and open
technique) of 40 patients each using the odd number policy for patient
allocation. Patients included in each group were further subdivided into two
groups according to the type of rectal resection either anterior resection (AR)
or abdominoperineal resection (APR). Erectile function was evaluated preoperatively
and postoperatively at 3 and 6 months using the International Index of Erectile
Function (IIEF) questionnaire. Results There was no significant difference
between the laparoscopic and open total mesorectal excision (TME) groups when
comparing IIEF score preoperatively. At 3 months postoperatively, the
laparoscopic arm showed better results over the open arm (abnormal IIEF in
57.5% vs. 67.5%). The study demonstrated dramatic improvement in SD in both groups at 6 months postoperatively (abnormal IIEF
score of 40% in the laparoscopic vs. 42.5% in the open arm) with no significant
difference in IIEF score between the two groups (p-value 0.876). At 3 and 6
months postoperatively, younger patients showed significant improvement in SD
compared to older patients in both groups with more significant improvement in
the laparoscopic group (16.7% vs. 40%). Patients
with APR show more SD compared with AR patients whether laparoscopic or open
as seen by the abnormal IIEF scores for the the two groups [the laparoscopic group
APR patients showed 62.5% abnormal IIEF at 3 months that decreased to 50% after 6 months compared to 56.3% and 37.5% at 3 and 6 months respectively for lap. AR patients, and in the open group APR patients
also showed higher abnormal IIEF of 71.4% and improved to 42.9% at 3 and 6 months respectively compared to 66.7% and 42.3% at 3 and 6 months respectively for open AR), which shows that APR whether laparoscopic or
open causes more sexual dysfunction than AR. Conclusion In this
randomized prospective study, there was no significant difference between the
laparoscopic and open TME when we compared IIEF scores. In patients younger
than 30 years, the significant improvement in the laparoscopic arm adds to the
favorable outcome of laparoscopic TME as regards postoperative complications,
postoperative pain, hospital stay, the return of bowel functions and cosmetic
results.