Sexual dysfunction, informed consent and multimodality therapy for rectal cancer

Chorost, Mitchell I.; Weber, Thomas K.; Lee, R.Jeffrey; Rodrı́guez-Bigas, Miguel A.; Petrelli, Nicholas J.

doi:10.1016/s0002-9610(00)00327-5

Cited by 58 publications

(45 citation statements)

References 18 publications

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“…In a recent series by Hendren et al [19], only 9% of the women and 39% of the men remembered discussing the sexual effects of treatment preoperatively. Previous studies [25] also have shown a failure to document possible effects of surgery in the informed consent process. These findings highlight the need for discussing and documenting sexual dysfunction as a surgical risk.…”

Section: Discussionmentioning

confidence: 99%

Male sexual and urinary function after laparoscopic total mesorectal excision

et al. 2008

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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

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Section: Discussionmentioning

confidence: 99%

Male sexual and urinary function after laparoscopic total mesorectal excision

et al. 2008

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“…The techniques differ greatly and include interviews, clinical tests and nonvalidated questionnaires. 4,5 Furthermore, factors such as age, gender adjuvant therapy and type of surgery can also have an impact on sexual function, but studies measuring this effect in a prospective way are rare. Finally, it is important to consider patients' quality of life (QoL) to determine whether such impairments disrupt everyday activities.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing sexual function in patients with rectal cancer

et al. 2005

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Only few studies have investigated the impact of surgery for rectal cancer on sexual function. Little of that research included quality of life (QoL) aspects and hardly any study analyzed the impact of age, gender and type of surgery on sexual function. The aim of the presented study was to address these issues. Over a 5 y period, EORTC-QLQ-C-30 and a tumor-specific module were prospectively administered to patients before surgery, at discharge, 3, 6, 12 and 24 months postoperatively. Comparisons were made between patients receiving abdominoperineal resection (APR), anterior resection (AR) with or without Pouch and Sigmoid resection. Furthermore, effects of surgery on female and male patients, and age groups were analyzed. A total of 819 patients participated in the study: 412 were males and 407 were females. The groups were comparable in terms of adjuvant treatment, tumor stage and histology. Patients after APR and AR with Pouch had worst sexual function. Men reported significantly more difficulties with sexual enjoyment; furthermore, over time, sexual problems created high levels of strain in men that were worse than baseline levels in the early postoperative period. These problems tended to remain. Patients aged 69 y and younger scored higher for problems with loss of sexual function and sexuality-related strain than patients aged 70 y and older. The findings in this study confirm that QoL changes postsurgery and that factors like type of surgery, gender and age have tremendous impact on sexual function and sexual enjoyment. APR and AR with Pouch affect sexual function more than AR and resection of the lower sigmoid. Through impaired sexual enjoyment, men are put more under strain than women. Patients aged 69 y and younger experience more stress through deteriorated sexual function.

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“…These are recognized complications after surgical resection of the rectum. 6,7 The incidence varies greatly and depends on the extent of resection and the surgical technique used. Reported values for bladder dysfunction range from 8 to 54 percent and for sexual dysfunction from 18 to 50 percent.…”

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confidence: 99%

Ten-Year Historic Cohort of Quality of Life and Sexuality in Patients With Rectal Cancer

Schmidt

Bestmann

Küchler

et al. 2005

Diseases of the Colon &Amp; Rectum

146

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Assessing quality of life with general and specific instruments is helpful to determine whether patients improved through the treatment. The study showed that gender, age, and type of surgery influence sexuality and that quality of life after surgery for rectal cancer is impacted. Because quality of life is a predictor for complications and survival, availability of such data may help to direct supportive treatment to improve outcome.

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Sexual dysfunction, informed consent and multimodality therapy for rectal cancer

Cited by 58 publications

References 18 publications

Male sexual and urinary function after laparoscopic total mesorectal excision

Male sexual and urinary function after laparoscopic total mesorectal excision

Factors influencing sexual function in patients with rectal cancer

Ten-Year Historic Cohort of Quality of Life and Sexuality in Patients With Rectal Cancer

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