Sexual function after radical surgery for rectal cancer

Advances and innovations in the multimodality therapy for rectal cancer have significantly improved oncologic outcomes with regard to overall and disease-specific survival. Accordingly, quality of life and functional outcomes are becoming increasingly important. Sexual dysfunction after treatment for rectal cancer has been reported in up to 69% of patients. However, the specific factors leading to sexual dysfunction are poorly understood with limited relevant data. This review aims to clarify the incidence of sexual dysfunction after radical rectal cancer resection and identify surgical contributing factors in an effort to improve quality of life outcomes and identify questions that should be addressed in future studies.     

Sexual function after rectal excision

BACKGROUND: Rectal excision is associated with a risk of autonomic nerve damage and associated sexual dysfunction (SD). The evolution of our understanding of the anatomy and physiology of sexual function together with continual refinement of surgery for both benign and malignant disease has led to a decrease in the incidence of SD after rectal surgery. A knowledge of the degree of risk of postoperative SD is important both for the patient and as a benchmark for audit of individual colorectal practice. METHODS: The available literature on the anatomy, physiology and surgical aspects of this topic has been researched through the Medline database. The more recently available data are reviewed in the context of the historical evolution of surgery for benign and malignant rectal disease. RESULTS AND CONCLUSIONS: In the best hands, permanent impotence occurs in less than 2% of patients following restorative proctocolectomy and at a similarly low rate after proctocolectomy and ileostomy. Isolated ejaculatory dysfunction is also numerically a minor problem post operation for benign disease. Patient age is the most important predictor of SD after surgery for rectal cancer. The incidence of permanent impotence remains high (>40%) after abdomino-perineal excision of the rectum (APE) but the continued decline in the use of this operation in favour of low anterior resection (LAR), which carries about half the risk of impotence compared to sphincter ablating surgery, is likely to have resulted in a fall in the absolute number of patients rendered impotent as a result of rectal cancer surgery. Anatomical dissection of the pelvis with preservation of the named autonomic fibres results in a low and predictable rate of sexual morbidity. Surgeons could profitably spend more time with their patients discussing the possible effects of surgery on sexual function. Further research is required to determine the effects of adjuvant therapy for rectal cancer on sexual function.     

套入式结肠直肠黏膜吻合保肛术对青年男性低位直肠癌术后性功能的影响

目的 探讨套入式结肠直肠黏膜吻合保肛术对青年男性低位直肠癌患者术后性功能的影响.方法 对68例低位直肠癌青年男性患者行套入式结肠直肠黏膜吻合术,分别于术前及术后调查其性功能.结果 68例患者中术后性功能障碍共发生22例,发生率32.35%,其中勃起障碍15例,射精障碍7例.6例Dukes A期患者均未发生性功能障碍,Dukes B期及C期患者术后性功能障碍发生率分别为26.67%及38.30%,两者差异有统计学意义(P＜0.05).结论 套入式结肠直肠黏膜吻合术可以很好地保护青年男性低位直肠癌患者的性功能,是一安全、有效的保肛术式.     

低位直肠癌经腹括约肌间切除术后患者肛门功能的影响因素分析

目的：探讨经腹括约肌间切除（ISR）术后肛门功能情况及其影响因素。方法回顾性分析2005年1月至2012年12月福建医科大学附属协和医院结直肠外科同一组医师实施经腹ISR治疗的96例低位直肠癌患者临床和随访资料。采用Wexner排粪失禁评分评估肛门功能,并通过Cox比例风险模型分析肛门功能的影响因素。结果96例经腹ISR患者均完成Wexner评分量表的评估,平均随访时间32．7月,其中83例（86．5％）排粪控制良好（Wexner评分小于10分）。Wexner评分与术后随访时间呈线性负相关（r＝-0．078,P＝0．003）。单因素分析显示,肿瘤距肛缘距离（P＝0．043）、吻合口距肛缘（P＝0．001）及新辅助放化疗（P＝0．001）与术后肛门失禁有关。多因素分析显示,吻合口距肛缘小于2 cm（P＝0．020）和新辅助放化疗（P＝0．001）是经腹ISR术后排粪失禁的独立危险因素。结论经腹ISR术后多数患者肛门功能良好,吻合口距肛缘不足2 cm和新辅助放化疗是影响术后肛门功能的独立危险因素。     

直肠癌手术对男性性功能和排尿功能的影响

目的　研究直肠癌患者术后性功能和排尿功能的变化。方法　对我院 79例直肠癌患者通过调查的方式调查术后性功能和排尿功能情况 ,并按年龄、术式进行回顾性分析。结果　性功能障碍小于 40岁患者为 3 7.5 % ,40 -5 9岁为 60 .4% ,大于 60岁为 95 .7%。Miles术后并发性功能障碍为 80 .5 % ,近期排尿困难为 46.3 % (1 9 41 ) ,远期排尿困难为 4.9% (2 41 ) ;Dixon术后并发性功能障碍5 5 .3 % ,近期排尿困难为 2 8.9% (1 1 3 8) ,无远期排尿困难。结论　男性直肠癌患者术后性功能和排尿功能障碍发生率高。手术时患者的年龄和手术方式对其发生率有直接影响。保留植物神经的直肠癌根治术可有效地减少患者术后性功能和排尿功能障碍     

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直肠癌特别是低位直肠癌的手术治疗,已不再满足于单纯的术后长期生存,对术后正常的生理功能和生活质量提出了更高的要求。由于近年来保留盆腔自主神经 (pelvicautonomicnervepreservation, PANP)、全直肠系膜切除术等新观念的导入,以及直肠癌浸润转移规律的重新认识和吻合器的使用,直肠癌的保功能手术得到不断完善和发展。在保证根治的前提下,解决好手术根治与保留功能间的关系,最大限度地保留排便、排尿及性功能符合现代直肠癌外科研究和发展的趋势,也成为直肠癌根治术的重要原则之一。近些年保肛手术的讨论较多,大多数观点已为公众…     

Sexual dysfunction after low anterior resection for midrectal cancer

Forty-nine patients under the age of 65 years, who had a low anterior resection performed for cancer of the midrectum, were interviewed. Eight patients were sexually inactive before the operation and were excluded. Postoperatively thirty-five had normal sexual function. Two male patients developed transient erectile impotence while two female patients had given up active sexual life after the operation because of dyspareunia. Two patients, one male and one female had permanent impairment. It is concluded, that severe sexual dysfunction can be seen after low anterior resection for cancer, but no early conclusion about permanent sexual dysfunction should be drawn.     

Risk factors for anastomotic leakage after resection for rectal cancer

Background

Controversy still exists concerning the impact of patient and tumor characteristics on anastomotic dehiscence after resection for rectal cancer.

Methods

Between January 1986 and July 2006, 472 patients underwent curative rectal resection. Patient and tumor characteristics, details of treatment, and postoperative results were recorded prospectively. Univariate and multivariate analysis were applied to identify risk factors for anastomotic leakage.

Results

In our patients, the anastomotic leak rate was 10.4% (49 of 472 patients), and mortality was 2.2% (1 of 49 patients). In univariate analysis, tumor diameter and absence of a protective stoma were associated with increased anastomotic leak rate, whereas American Society of Anesthesiologists (ASA) score and tumor localization showed borderline significance. In multivariate analysis, tumor diameter, tumor localization, and absence of a protective stoma were significantly associated with anastomotic leakage.

Conclusions

Patients with large and low lying rectal tumors are at high risk for anastomotic leakage. A protective stoma significantly decreases the rate of clinical leaks and subsequent reoperation after low anterior resection.     

男性直肠癌切除术后性功能障碍分析

对25例男性直肠癌切除后性功能进行调查。平均年龄为42．5岁，Miles手术18例，性欲减退8例（44．4％），勃起障碍11例（61.1％），射精障碍13例（72．2％）。Dixon手术7例，性欲减退1例（14.3％），勃起障碍1例（14.3％），射精障碍2例（28．6％）。认为手术损伤盆腔神经是造成术后病人性功能障碍的直接和主要因素。防治关键在于术中完整地保护植物神经，注意剥离层次和切除范围。     

Anorectal function after partial intersphincteric resection in ultra‐low rectal cancer

Aim To investigate the feasibility and efficacy of intersphincteric resection (ISR), in terms of postoperative anorectal function, for ultra‐low rectal cancer in mainland China. Method A total of 43 patients who consecutively underwent curative partial ISR for ultra‐low rectal cancer between 2006 and 2009 were enrolled in the study. Defaecatory function was assessed, using detailed questionnaires, 3, 6 and 12 months after surgery. The Wexner score was used to assess faecal continence, and anal manometry studies were performed to analyse anal sphincter function. Results Overall defaecatory function was assessed as being satisfactory in 41 of 43 patients. Twelve months after surgery, the mean Wexner score was 4.0 ± 3.6. Anal manometry studies showed a significant change at 3 months and further, gradual, improvement over the following year. During the postoperative period, maximum squeeze pressure reached a normal value of 174.1 ± 19.5 mmHg (P = 0.041) by 6 months and resting pressure was 42.4 ± 5.6 mmHg by 12 months, which was close to the preoperative level (P = 0.038). Conclusion Because of the satisfactory recovery of defaecatory function and good oncological results, partial ISR may be recommended as an effective sphincter‐preserving operation for patients with ultra‐low rectal cancer.     

腹腔镜直肠癌手术的应用体会

目的:探讨腹腔镜直肠癌手术的难度预测、手术要点及并发症的防治。方法:回顾分析98例患者行腹腔镜直肠癌手术的临床资料,总结与手术难度相关的因素。结果:中转开腹15例(15.3%),术后吻合口瘘1例(1.0%),切口感染4例(4.0%),并发粘连性肠梗阻再次开腹分离粘连1例(1.0%),输尿管损伤2例(2.0%),排尿困难3例(3.0%),无围手术期死亡病例。结论:手术难度同瘤体位置、肿瘤长径与坐骨棘间距比(T/I比)相关,T/I比有望成为术前预测腹腔镜手术难度的重要参考指标。Endo-Cutter切断直肠困难为中转开腹的主要原因。     

Anorectal complications after robotic intersphincteric resection for low rectal cancer

Background

Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR.

Methods

The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed.

Results

Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23–89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41–162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P?=?0.043), and male gender was a significant risk factor for anal stenosis (P?=?0.007).

Conclusions

This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.