Urogenital Function After Robotic-Assisted Laparoscopic Rectal Cancer Surgery

James Tak-kwan Fung, FRCSEd, Hester Yui-shan Cheung, FRACS, Lawrence Wing-chiu Ng, FRACS, Chi Chiu Chung, FRCSEd, Michael Ka-wah Li, FRCS FRCSEd. Department of Surgery, Pamela Youde Nethersole Eastern Hospital

Introduction : Despite improvement in surgical approach and technology, total mesorectal excision for low rectal cancer has been associated with significant post-operative sexual and urinary dysfunction. We hypothesize that robot-assisted laparoscopic total mesorectal excision can achieve maintenance of such functions by its more assured pelvic splanchnic nerve preservation.

Method: We prospectively assessed the pre- and post-operative sexual and urinary function of male patients who received robot-assisted laparoscopic total mesorectal excision for rectal cancer since May 2009. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) were employed for such assessment. The baseline and the post-op 3 months assessments of sexual and urinary function were analyzed and compared.

Results: In the 24-month period of study, twenty-six male patients were recruited. Their mean age was 64 years (range 33-85). Eighteen patients (69.2%) received sphincter-preserving resection of rectum. Eight patients (30.8%) had either neoadjuvant or adjuvant irradiation as a part of their treatment. The mean baseline and post-op 3 months IPSS were 3.8 and 4.0 respectively. There was no significant difference in IPSS after operation. Eleven patients (42.3%) were sexually active before the operation. The mean baseline and post-op 3 months IEFF-5 were 13.3 and 10.4 respectively. There was no significant difference in IEFF-5 after operation.

Conclusion: In contrast to traditional open or laparoscopic total mesorectal excision, our preliminary data in robot-assisted laparoscopic rectal cancer excision is encouraging and suggests that robot is more than just a surgeon’s tool but the clarity of the surgeon’s view and the ease by which the surgeon operate can be translated into better functional outcomes in our patients.

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