Male Urinary and Sexual Dysfunction After Laparoscopic Versus Robot-Assisted Total Mesorectal Excision for Rectal Cancer

Jong Pil Ryuk, MD, Gyu-seog Choi, MD, Jun Seok Park, MD, Soo Yeun Park, MD, Hye Jin Kim, MD, Whon-ho Choi, MD. Kyungpook National University Medical Center


Introduction Urinary and sexual dysfunction are recognized complications of rectal cancer surgery in male individuals. This study compares the efficacy of robot-assisted total mesorectal excision (RTME) and laparoscopic total mesorectal excision (LTME) in improving functional outcomes.
Methods Between February 2009 and September 2010, 25 male patients who underwent RTME and 25 male patients who underwent LTME were followed up for at least 12 months. These patients were matched 1:1 by age, surgery date, tumor height, neoadjuvant chemoradiation, and tumor stage. Urinary and sexual function were evaluated using validated questionnaires, including those pertaining to the International Prostatic Symptom Score (IPSS) and 5-item version of the International Index of Erectile Function (IIEF-5) score, the scores were obtained at 3, 6, and 12 months after surgery and were compared with the scores before surgery.
Results The data for the groups were found to be similar in terms age, surgery date, operative procedure, tumor location, T stage, TNM stage of the resected specimen, and use of protective ileostomy and adjuvant chemotherapy. The mean IPSS score did not significantly differ between the RTME and LTME groups at 3,6, and 12 months. However, in the RTME group, the degree of increase in the IPSS score was significantly lesser than that in the LTME group at 6 months (1.28 ± 1.46 vs. 2.64 ± 2.60, P = 0.050). Seventeen RTME patients and 17 LTME patients who had sexual activity before rectal cancer surgery could be followed up for the IIEF-5. The use of RTME was associated with greater improvement in the IIEF score than the use of LTME at 3, 6, and 12 months, and this difference was statistically significant at 6 months (14.00 ± 6.22 vs. 9.06 ± 6.64, P = 0.027).
Conclusions The RTME group patients experienced earlier restoration of bladder and sexual function than the LTME group patients. These functional outcomes suggest the efficacy of the robotic approach for rectal cancer surgery.

Session Number: SS22 – Robotics
Program Number: S119

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