Sexual dysfunction following rectal cancer surgery
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Sexual and urological problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. The urogenital function is dependent on dual autonomic sympathetic and parasympathetic innervation, and four key danger zones exist that are at risk for nerve damage during colorectal surgery: one of these sites is in the abdomen and three are in the pelvis. The aim of this study is to systematically review the epidemiology of sexual dysfunction following rectal cancer surgery, to describe the anatomical basis of autonomic nerve-preserving techniques, and to explore the scientific evidence available to support the laparoscopic or robotic approach over open surgery.
According to the PRISMA guidelines, a comprehensive literature search of studies evaluating sexual function in patients undergoing rectal surgery for cancer was performed in Medline, Scopus, Web of Science, Embase, and Cochrane Central Register of controlled trials.
An increasing number of studies assessing the incidence and prevalence of sexual dysfunction following multimodality treatment for rectal cancer has been published over the last 30 years. Significant heterogeneity in the prevalence of sexual dysfunction is reported in the literature, with rates between 5 and 90%.
There is no evidence to date in favor of any surgical approach (open vs laparoscopic vs robotic). Standardized diagnostic tools should be routinely used to prospectively assess sexual function in patients undergoing rectal surgery.
KeywordsSexual dysfunction Rectal cancer Colorectal surgery Nerve sparing surgery Erectile dysfunction
Compliance with ethical standards
Conflict of interest statement
The authors declare that there is no conflict of interest.
- 7.Tanagho E, McAninch JW. Smith’s general urology, 17th Edition. McGraw-Hill (2007).Google Scholar
- 8.Hatzimouratidis K, Eardley I, Giuliano F et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European Association of Urology 2014.Google Scholar
- 10.Moher D, Liberati A, Tetzlaff J, Altman DG (2009) The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses. The PRISMA StatementBMJ 339:b2535Google Scholar
- 23.Pietrangeli A, Pugliese P, Perrone M et al (2009) Sexual dysfunction following surgery for rectal cancer—a clinical and neurophysiological study. J Exp Clin Cancer Res 17:28–128Google Scholar
- 30.Kim JY, Kim NK, Lee KY et al (2012) A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol 19(8):2485–2493. doi: 10.1245/s10434-012-2262-1 CrossRefPubMedGoogle Scholar
- 36.Wang G, Wang Z, Jiang Z et al (2016) Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot 8. doi: 10.1002/rcs.1725
- 61.Vennix S, Pelzers L, Bouvy N et al. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. (2014) Apr 15;(4).Google Scholar
- 67.Park SY, Choi GS, Park JS et al (2014) Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methodsfor the treatment of rectal cancer: a case-matched comparison. World J Surg 38(7):1834–1842. doi: 10.1007/s00268-013-2419-5 CrossRefPubMedGoogle Scholar
- 73.McLachlan SA, Fisher RG, Zalcberg J et al (2016) The impact on health-related quality of life in the first 12 months: a randomised comparison of preoperative short-course radiation versus long-course chemoradiation for T3 rectal cancer (Trans-Tasman Radiation Oncology Group Trial 01.04). Eur J Cancer 55:15–26CrossRefPubMedGoogle Scholar
- 74.Kneist W. Minimal invasive pelvic neuromonitoring—technical demands and requirements. Biomed Tech (Berl) 2013 (s1).Google Scholar