A Comparative Study of Voiding and Sexual Function after Total Mesorectal Excision with Autonomic Nerve Preservation for Rectal Cancer: Laparoscopic Versus Robotic Surgery

Purpose

To evaluate the protection of the urogenital function after robot-assisted total mesorectal excision (R-TME) for rectal cancer compared to those of laparoscopic TME (L-TME).

Methods

69 patients who underwent L-TME (n?=?39) or R-TME (n?=?30) were prospectively enrolled. Their urogenital function was evaluated by uroflowmetry, a standard questionnaire of the international prostate symptom score (IPSS) and the international index of erectile function (IIEF) before surgery and 1, 3, 6, and 12?months after surgery. The pre- and postoperative IPSS and IIEF scores were compared to detect functional deterioration by paired t test for each group. How postoperative IPSS and IIEF scores and uroflowmetry data deviated from the preoperative values (??) were statistically compared between the two groups.

Results

The IPSS score significantly increased 1?month after surgery; the recovery from decreased urinary function took 6?months for patients in the L-TME group (8.2?±?6.3; P?=?0.908) but 3?months in the R-TME group (8.36?±?5.5; P?=?0.075). The ??IPSS scores were significantly different between the two groups at 3?months (P?=?0.036). In male patients (L-TME 20, R-TME 18), the total IIEF score in R-TME and L-TME significantly decreased 1?month after surgery, L-TME gradually recovered over 12?months (46.00?±?16.9; P?=?0.269), but R-TME recovered within 6?months (44.61?±?13.76; P?=?0.067). The ??IIEF score value was not significantly different at any time between the two groups, but in an itemized analysis of the change in erectile function and sexual desire, there were significant differences at 3?months between the two groups.

Conclusions

R-TME for rectal cancer is associated with earlier recovery of normal voiding and sexual function compared to patients who underwent L-TME, although this result needs to be verified by larger prospective comparative studies.