To explore the frequency and predictive factors of erectile dysfunction diagnosis after colorectal cancer surgery. The Surveillance, Epidemiology, and End Results-Medicare database was used to identify a national sample of men undergoing surgery for colorectal cancer from 2004 to 2015. Men aged > 65 years with any index surgery within 1 year of diagnosis of colorectal cancer were included. Men with a history of prior erectile dysfunction, metastatic cancer, or genitourinary cancer prior to their index procedure were excluded. The primary outcome was a new diagnosis of erectile dysfunction within 2 years of the index procedure. A total of 28,248 men aged > 65 years who underwent colorectal cancer surgery were identified. The rates of erectile dysfunction diagnosis 2 years after surgery were 3.6% for hemicolectomy, 5.3% for low anterior resection, and 6.4% for abdominoperineal resection. On multivariable analysis, low anterior resection (HR: 1.27, 95%CI 1.08 to 1.51, p < 0.01) and abdominoperineal resection (HR: 1.49, 95%CI 1.14 - 1.93, p < 0.01) were independently associated with increased risk of erectile dysfunction compared to hemicolectomy. Minimally invasive surgery was independently associated with an increased risk of erectile dysfunction compared to open surgery (HR: 1.44, 95% CI 1.25-1.65, p < 0.001). Compared to hemicolectomy, men treated with low anterior resection and abdominoperineal resection have a higher risk of being diagnosed with erectile dysfunction within 2 years of treatment. The absolute rate of erectile dysfunction diagnosis was low compared to rates reported in prior controlled trials, suggesting that patients are underdiagnosed in real-world settings.
Keywords: Abdominoperineal resection; Colorectal cancer; Erectile dysfunction; Low anterior resection.
© 2024. Italian Society of Surgery (SIC).