Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain.
Colorectal Dis. 2021 Jun;23(6):1379-1392. doi: 10.1111/codi.15589. Epub 2021 Mar 12.
The aim of this study was to assess the evolution of sexual function over time after rectal cancer surgery and to identify risk factors that may have an impact on the deterioration of postoperative function.
This was a prospective cohort study of sexual function after rectal cancer surgery using the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) preoperatively and at 6 and 12 months after surgery. Predictive factors of worsening were identified by univariate and multivariate analysis.
One hundred and one patients were included (56 men and 45 women). In men, the average IIEF showed decreased erectile function and intercourse satisfaction at 6 months (respectively 21.58 ± 7.18 to 16.60 ± 7.96, p = 0.002 and 10.87 ± 2.94, to 8.09 ± 4.45, p = 0.002) with recovery at 1 year. As a percentage, erectile dysfunction increased from the preoperative value to 6 months (64.5% vs 87.1%, p = 0.022) and was observed in 72% at 1 year. Patients with moderate to severe dysfunction increased from 22% preoperatively to 58% (p = 0.009) at 6 months and 44% at 1 year (p < 0.0001). Neoadjuvant chemoradiotherapy (OR 5.4, 95% CI 0.9-29.6; p = 0.041) and erectile worsening at 6 months (OR 20, 95% CI 1.6-238; p = 0.004) were independent factors for worse function at 6 or 12 months, respectively. No significant worsening of the FSFI was found, although there was an improvement in lubrication and orgasm.
Temporary deterioration of erectile function in men is common at 6 months after surgery and chemoradiotherapy is the only predictive factor. Furthermore, patients who remain dysfunctional show an increase in the severity of symptoms in relation to the preoperative period.
本研究旨在评估直肠癌手术后性功能的随时间演变，并确定可能影响术后功能恶化的风险因素。
这是一项使用国际勃起功能指数（IIEF）和女性性功能指数（FSFI）对直肠癌手术后性功能进行的前瞻性队列研究，分别在术前和术后 6 个月和 12 个月进行。通过单变量和多变量分析确定预测功能恶化的因素。
共纳入 101 例患者（56 例男性和 45 例女性）。在男性中，平均 IIEF 显示勃起功能和性交满意度在 6 个月时下降（分别为 21.58±7.18 降至 16.60±7.96，p=0.002 和 10.87±2.94，降至 8.09±4.45，p=0.002），并在 1 年内恢复。以百分比表示，勃起功能障碍从术前值增加到 6 个月（64.5%比 87.1%，p=0.022），并在 1 年内观察到 72%。中度至重度功能障碍患者从术前的 22%增加到 6 个月时的 58%（p=0.009）和 1 年时的 44%（p<0.0001）。新辅助放化疗（OR 5.4，95%CI 0.9-29.6；p=0.041）和 6 个月时勃起功能恶化（OR 20，95%CI 1.6-238；p=0.004）是 6 个月或 12 个月时功能恶化的独立因素。虽然润滑和 orgasm 有所改善，但 FSFI 没有明显恶化。
男性手术后 6 个月勃起功能暂时恶化较为常见，放化疗是唯一的预测因素。此外，持续功能障碍的患者与术前相比，症状严重程度增加。
