Effect of open versus 3D laparoscopic surgery for rectal cancer on male urinary and sexual function

Objective To prospectively assess the sexual and urinary functions as well as factors influencing these functions in patients undergoing open or 3D laparoscopic surgery for rectal cancer. Methods A retrospective analysis was performed of the clinical data of 37 male rectal cancer patients treated at Shougang Hospital, Peking University from January 2015 to October 2016. Their sexual and urinary functions were assessed through self-administered questionnaires comprising the International Index of Erectile Function (IIEF; sexual function) and the International Prostate Symptom Score (IPSS; urinary function) before and 3, 6, and 12 months after surgery. Age, body mass index (BMI), operation time, and blood loss were compared between the two groups by the t-test. Tumor TNM stage, tumor location, N stage, T stage, surgical procedure, complications, and chemotherapy were compared by the chi-square test. The influence of each of these observation factors on IIEF and IPSS scores was analyzed by the rank sum test. The influencing factors on IIEF and IPSS scores at 12 months after operation were analyzed by multiple linear regression. Results Fifteen patients who underwent 3D laparoscopic surgery and 22 patients who underwent open surgery were finally analyzed in this study. There were no significant differences in age, BMI, TNM stage, N stage, T stage, surgical procedure, complications, or chemotherapy between the two groups (P>0.05). The operation time of the 3D laparoscopic operation group was significantly longer than that of the traditional open surgery group [(222.67±41.40) min vs (159.36±21.26) min, F=6.414, P 500 ml during operation decreased significantly at 3, 6, and 12 months after operation (Z=-2.785, -2.644, -2.538, P<0.05). The IPSS scores of the elderly group were significantly higher than those of the younger group at 3, 6, and 12 months (H=15.810, 17.926, 18.162, P<0.05). The IPSS score of patients with low tumor location was significantly higher than that of patients with high tumor location (Z=-0.268, P=0.045) at 3 months after operation. Multiple linear regression analysis showed that age, tumor location, and blood loss were correlated with sexual function at 12 months after operation (P=0.039, 0.001, 0.019). Age was a risk factor for urinary function at 12 months after operation (P<0.05). Conclusions The type of surgery is not a risk factor affecting sexual function and urinary function. Age, tumor location, and blood loss are risk factors for sexual dysfunction, while age is a risk factor for urinary dysfunction. Key words: 3D laparoscopic surgery; Rectal cancer; Sexual function; Urinary function