Comparative study of voiding and sexual function between open and laparoscopic total mesorectal excision in patients with rectal cancer

Abstract

Voiding and sexual dysfunction are common complication after rectal cancer surgery. The aim of this study was to evaluate and compare these functional outcomes between open and laparoscopic surgery. 97 patients (62 male and 35 female) who underwent open (N=41) or laparoscopic (lapa) (N=56) surgery for rectal cancer were prospectively enrolled between April 2008 and August 2009. We performed urine flowmetry and standard questionnaires using the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF). All study and questionnaires were performed preoperatively and one month, 3 months, 6 months, and 12 months after surgery. Overall voiding function score increased one month after surgery (open: 9.3±4.6 to 14.0±8.2, lapa: 8.3±5.3 to 12.3±5.2; P=0.002, P<0.001, respectively), and after 6 months, the score still increased in both groups, but had no statistical significance (open: 9.9±4.5, lapa: 9.2±5.6; P=0.546, P=0.280, respectively). After 12 months, the score was similar with preoperative status (open: 9.6±5.3, lapa: 8.4±4.6; P=0.760, P=0.815, respectively). Significant decrease in peak flow rate and voiding volume were seen until 6 months after surgery, but recovery was observed after 12 months in both groups. Residual volume increased until 6 months after surgery, but returned to preoperative status after 12 months. In 33 male patients, overall sexual function and domain scores were significantly decreased after surgery in both groups. Overall sexual function score showed recovery as time passes, but significantly decreased until 12 months after open surgery (N=17) (before: 55.2±9.8, one month: 20.9±13.7, 6 months: 42.7±16.8, 12 months: 48.7±15.9). In laparoscopic surgery group (N=16), overall sexual function also decreased until 6 months after surgery, but showed similar status at 12 months (before: 55.4±9.0, one month: 21.7±11.2, 6 months: 48.7±12.9, 12 months: 52.2±11.7). Domain scores including erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction showed the similar pattern. Significant differences in sexual function, in both overall score and individual symptom scores, were detected at 6 months after surgery between laparoscopic and open groups, but there are no significant differences at other time points. Of 33 patients who had normal ejaculation ability before surgery, 26 patients (79%) {open: 13 (76.5%), lapa: 13 (81.3%)} showed normal function after 12 months. Voiding and male sexual function significantly decreased after both open and laparoscopic surgery. Voiding function recovered after 6months in both groups, but sexual function recovered more quickly in the laparoscopic group and returned to preoperative status after 12 months. Laparoscopic rectal cancer surgery showed similar outcomes in voiding function compared with open surgery and a trend of early recovery in sexual function.