Sexual function outcomes after laparoscopic Extra-levator Abdomino-perineal Resection (ELAPR) in the Enhanced Recovery After Surgery (ERAS) setting

Abstract

Objectives: Patient outcomes are maximised in the enhanced recovery setting although the sexual function outcomes of patients undergoing laparoscopic extra-levator abdomino-perineal resection (ELAPR) performed in the enhanced recovery after surgery (ERAS) setting are currently not fully explored. This study aimed to identify objectively the short-term outcomes of these patients. Methods: Data for this observational study were collected retrospectively from consecutive male patients undergoing ELAPR. Basic demographic data, neo-adjuvant therapy, operative details, complications and International Index of Erectile Function (IIEF-5) scores were recorded pre and post procedure. Results: In total 14 patients underwent consecutive ELAPR. Median age was 67 years (range 54-86). 7 patients received neo-adjuvant pelvic radiotherapy. Median follow-up was 21 months (range 8-50). IIEF scores were globally reduced after surgery for each domain: erectile dysfunction (18.4 vs. 8.9, p¼0.028, mild-to-moderate to moderate dysfunction), orgasmic function (7.9 vs. 4.0, p¼0.01, mild to moderate dysfunction), sexual desire (6.6 vs. 4.9, p¼0.076, mild-to-moderate to moderate dysfunction), intercourse satisfaction (9.3 vs. 4.5, p<0.035, mild-to-moderate to moderate dysfunction), overall satisfaction (7.6 vs. 4.1, p<0.005, mild to moderate dysfunction). IIEF scores were lower after surgery in patients receiving neo-adjuvant therapy (mean reduction in domain score 6.65 vs. 2.6, p¼0.08). Erectile dysfunction was significantly worse after ELAPR following neo-adjuvant treatment (mild-to-moderate to severe dysfunction, p¼0.01), compared with ELAPR alone (mild-to-moderate dysfunction unchanged, p¼0.43). Conclusion: ELAPR significantly worsens male sexual function in the short term, exacerbated by neo-adjuvant chemo-radiation. In the ERAS setting, other factors such as surgeon's experience and technique, treatment modalities and pre-and post-procedure psychosocial factors should be explored in future studies to improve outcomes. Disclosure of interest: None declared. Scale range¼18-126. Results are mean difference (95% CI), unless specified. *Hypothesis supported Abstracts / Clinical Nutrition ESPEN 12 (2016) e30ee59 e45