Background: Sexual and urinary dysfunction is an established risk after pelvic surgery. Studies examining sexual and urinary function following laparoscopic and open rectal surgery give conflicting evidence for outcomes. The purpose of this study was to analyse the impact of the surgical technique on functional outcomes following laparoscopic or open resection for rectal cancer patients in a high-volume laparoscopic unit.
Methods: All patients who underwent elective laparoscopic or open surgery for rectal cancer between September 2006 and September 2009 were identified from a prospectively collated database. Validated standardized postal questionnaires were sent to surviving patients to assess their postoperative sexual and urinary function. The functional data were then quantified using previously validated indices of function.
Results: A total of 173 patients were identified from the database, of whom 144 (83 %) responded to the questionnaire-based study. Seventy-eight respondents had undergone laparoscopic rectal resection (49 men and 29 women), and 65 had an open procedure (41 men and 24 women). Both open surgery and laparoscopic surgery were associated with deterioration in urinary and sexual function. With regard to urinary function, there was no difference in the deterioration in open and laparoscopic groups in either gender. With regard to sexual function, in males one component of sexual function, namely, the incidence of successful penetration, showed less deterioration in the laparoscopic group (p = 0.04). However, in females, laparoscopic surgery was associated with significantly better outcomes in all aspects of sexual activity, specifically sexual arousal (p = 0.005), lubrication (p = 0.001), orgasm (p = 0.04), and the incidence of dyspareunia (p = 0.02).
Conclusion: Laparoscopic total mesorectal excision for rectal cancer is associated with significantly less deterioration in sexual function compared with open surgery. This effect is particularly pronounced in women.