Background Urinary and sexual dysfunction are potential complications of rectal surgery for cancer. This study retrospectively evaluated the frequency of such complications after laparoscopic total mesorectal excision (LTME) with autonomic nerve preservation. Methods For this study, 50 men younger than 75 years who underwent radical LTME for mid and low rectal cancer were followed up for at least 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. Results Sexual desire was maintained by 55.6%, ability to engage in intercourse by 57.8%, and ability to achieve orgasm and ejaculation by 37.8% of the patients. Distance of the tumor from the anal verge and adjuvant or neoadjuvant treatments were the significant predictors of poor postoperative sexual function. Seven patients (14%) presented transitory postoperative urinary dysfunction, all of whom were medically treated. Tumor stage and distance from the anal verge were independently associated with the postoperative global International Prostatic Symptom Score (IPSS). No differences were observed in urinary quality of life. Conclusions In this series, LTME did not reproduce or improve on sexual and urinary dysfunction outcomes obtained in the best open TME series. Further trials are needed to evaluate functional outcome in rectal cancer patients.Keywords Urinary dysfunction Á Sexual dysfunction Á Quality of life Á Laparoscopy Á Total mesorectal excision Á Rectal cancer Laparoscopic total mesorectal excision (TME) for rectal cancer is technically feasible, offering acceptable complication rates and short-term oncologic outcomes comparable with those for open surgery [1][2][3][4][5][6][7][8]. However, quality of life (QoL) must not be forgotten in the quest for oncologic excellence. Postoperative urinary and sexual dysfunction resulting from inadvertent damage to the pelvic hypogastric and splanchnic nerves are recognized complications of rectal resection [9][10][11].Laparoscopic surgery, although technically demanding and associated with a long learning curve, has the advantage of clear visualization for the smallest structures, including the autonomic nerves. The use of the laparoscopic approach for the treatment of rectal cancer could therefore facilitate preservation of the pelvic autonomic nerves. Nevertheless, data on the functional outcome of laparoscopic TME are limited and controversial [12,13].This retrospective clinical study aimed to evaluate male sexual and functional outcomes in a consecutive series of patients who underwent laparoscopic surgery for lower and middle rectal cancer at our institutions. Materials and methodsMale patients with a diagnosis of cancer in the mid or distal rectum were identified from a prospective database of 850 patients who underwent laparoscopic colorectal resection. The site of rectal neoplasm was defined according to the

The authors' early experience with robotic surgery suggests that it is safe and could be an effective alternative to conventional laparoscopic surgery. The authors believe that robotic surgery, with its ability to restore the hand-eye coordination and three-dimensional view lost in laparoscopic surgery, could allow complex procedures to be performed with greater precision and better results.

Laparoscopic TME is a feasible but technically demanding procedure (12% conversion rate). This series confirms the safety of the procedure, while oncologic results are at present comparable to the open published series with the limitation of a short follow-up period. Further studies and possibly randomized series will be necessary to evaluate long-term clinical outcome in cancer patients.

Laparoscopic TME is a feasible but technically demanding procedure (12% conversion rate). This series confirms the safety of the procedure, while oncologic results are at present comparable to the open published series with the limitation of a short follow-up period. Further studies and possibly randomized series will be necessary to evaluate long-term clinical outcome in cancer patients.

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