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Impact of Robotic Surgery on Sexual and Urinary Functions After Fully Robotic Nerve-Sparing Total Mesorectal Excision for Rectal Cancer

Luca, Fabrizio MD*; Valvo, Manuela MD*; Ghezzi, Tiago Leal MD; Zuccaro, Massimiliano MD*; Cenciarelli, Sabina MD*; Trovato, Cristina MD; Sonzogni, Angelica MD§; Biffi, Roberto MD*

doi: 10.1097/SLA.0b013e318269d03b
Original Articles
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Background: Urinary and sexual dysfunctions are recognized complications of rectal cancer surgery. Their incidence after robotic surgery is as yet unknown. The aim of this study was to prospectively evaluate the impact of robotic surgery for rectal cancer on sexual and urinary functions in male and female patients.

Methods and Procedures: From April 2008 to December 2010, 74 patients undergoing fully robotic resection for rectal cancer were prospectively included in the study. Urinary and sexual dysfunctions affecting quality of life were assessed with specific self-administered questionnaires in all patients undergoing robotic total mesorectal excision (RTME). Results were calculated with validated scoring systems and statistically analyzed.

Results: The analyses of the questionnaires completed by the 74 patients who underwent RTME showed that sexual function and general sexual satisfaction decreased significantly 1 month after intervention: 19.1 ± 8.7 versus 11.9 ± 10.2 (P < 0.05) for erectile function and 6.9 ± 2.4 versus 5.3 ± 2.5 (P < 0.05) for general satisfaction in men; 2.6 ± 3.3 versus 0.8 ± 1.4 (P < 0.05) and 2.4 ± 2.5 versus 0.7 ± 1.6 (P < 0.05) for arousal and general satisfaction, respectively, in women. Subsequently, both parameters increased progressively, and 1 year after surgery, the values were comparable to those measured before surgery. Concerning urinary function, the grade of incontinence measured 1 year after the intervention was unchanged for both sexes.

Conclusions: RTME allows for preservation of urinary and sexual functions. This is probably due to the superior movements of the wristed instruments that facilitate fine dissection, coupled with a stable and magnified view that helps in recognizing the inferior hypogastric plexus.

This study prospectively evaluated the impact of robotic rectal cancer surgery on sexual and urinary functions. The analyses of the questionnaires showed that sexual and urinary functions decreased significantly 1 month after intervention, then both parameters increased progressively, and 1 year after surgery, the values were comparable to those measured before surgery.

*Division of Abdomino-Pelvic Surgery, European Institute of Oncology, Milano, Italy

Moinhos de Vento Hospital, Porto Alegre, Brazil

Division of Endoscopy, European Institute of Oncology, Milano, Italy

§Division of Pathology, European Institute of Oncology, Milano, Italy.

Reprints: Fabrizio Luca, MD, Division of Abdomino-Pelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milano, Italy. E-mail: fabrizio.luca@ieo.it.

Disclosure: No funding or other financial support was received for this research. The authors declare that there is neither actual nor potential conflicts of interest with reference to this article.

Each person listed as author meets all of the following 3 conditions: made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; participated in drafting the article or revising it critically for important intellectual content; and gave final approval of the version to be published.

© 2013 Lippincott Williams & Wilkins, Inc.