Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique

Abstract

Background: Bladder and sexual dysfunction are recognized complications of mesorectal resection. Their incidence following laparoscopic surgery is unknown. Methods: Bladder and sexual function were assessed in patients who had undergone laparoscopic rectal, open rectal or laparoscopic colonic resection as part of the UK Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial, using the International Prostatic Symptom Score, the International Index of Erectile Function and the Female Sexual Function Index. Sexual and bladder function data from the European Organization for Research and Treatment of Cancer QLQ-CR38 collected in the CLASICC trial were used for comparison. Results: Two hundred and forty-seven (71·2 per cent) of 347 patients completed questionnaires. Bladder function was similar after laparoscopic and open rectal operations for rectal cancer. Overall sexual function and erectile function tended to be worse in men after laparoscopic rectal surgery than after open rectal surgery (overall function: difference − 11·18 (95 per cent confidence interval (c.i.) −22·99 to 0·63), P = 0·063; erectile function: difference −5·84 (95 per cent c.i. −10·94 to −0·74), P = 0·068). Total mesorectal excision (TME) was more commonly performed in the laparoscopic rectal group than in the open rectal group. TME (odds ratio (OR) 6·38, P = 0·054) and conversion to open operation (OR 2·86, P = 0·041) were independent predictors of postoperative male sexual dysfunction. No differences were detected in female sexual function. Conclusion: Laparoscopic rectal resection did not adversely affect bladder function, but there was a trend towards worse male sexual function. This may be explained by the higher rate of TME in the laparoscopic rectal resection group.