Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Colorectal Dis. 2023 May;25(5):932-942. doi: 10.1111/codi.16508. Epub 2023 Feb 21.
The aim of this work was to investigate the risk factors associated with the incidence of sexual dysfunction in patients who underwent robot-assisted surgery with several treatment options, such as neoadjuvant chemoradiotherapy and lateral lymph node dissection, and clarify the longitudinal course of erectile function in risk groups.
A total of 203 male patients who underwent robot-assisted total mesorectal excision for rectal cancer between 2013 and 2019 were included. The risk factors for erectile and ejaculatory dysfunction as well as the longitudinal course of erectile function were retrospectively investigated in all cohorts and several risk groups, including those who underwent neoadjuvant chemoradiotherapy, lateral lymph node dissection and adjuvant chemotherapy. Erectile dysfunction was assessed using the International Index of Erectile Function and ejaculatory dysfunction was assessed using original questions. The survey was performed preoperatively and at 3, 6 and 12 months postoperatively.
Erectile and ejaculatory dysfunction occurred in 46.8% and 15.7% of the patients, respectively. Multivariate analysis showed that neoadjuvant chemoradiotherapy was an independent risk factor for erectile dysfunction. Erectile function recovered longitudinally to the preoperative level overall, as well as in lateral lymph node dissection and postoperative adjuvant chemotherapy subgroups; however, recovery was poor in the neoadjuvant chemoradiotherapy group, even at 12 months postoperatively.
Neoadjuvant chemoradiotherapy was found to be a risk factor for erectile dysfunction after robot-assisted surgery for rectal cancer. Erectile function recovered postoperatively in patients undergoing lateral lymph node dissection; however, those receiving neoadjuvant chemoradiotherapy showed poor recovery, even at 12 months postoperatively.
本研究旨在探讨接受机器人辅助手术治疗的患者发生性功能障碍的相关风险因素，这些患者可选择多种治疗方案，如新辅助放化疗和侧方淋巴结清扫，并阐明高危组勃起功能的纵向变化过程。
共纳入 203 例 2013 年至 2019 年间接受机器人辅助全直肠系膜切除术治疗直肠癌的男性患者。回顾性分析所有队列和多个风险组（包括接受新辅助放化疗、侧方淋巴结清扫和辅助化疗的患者）的勃起和射精功能障碍的风险因素以及勃起功能的纵向变化过程。使用国际勃起功能指数评估勃起功能障碍，使用原始问题评估射精功能障碍。在术前和术后 3、6 和 12 个月进行调查。
分别有 46.8%和 15.7%的患者出现勃起和射精功能障碍。多变量分析显示，新辅助放化疗是勃起功能障碍的独立危险因素。总体上以及在侧方淋巴结清扫和术后辅助化疗亚组中，勃起功能均呈纵向恢复至术前水平，但在新辅助放化疗组中，即使在术后 12 个月时，恢复情况仍较差。
新辅助放化疗被发现是机器人辅助直肠癌手术后勃起功能障碍的一个危险因素。接受侧方淋巴结清扫的患者术后勃起功能恢复，但接受新辅助放化疗的患者恢复情况较差，即使在术后 12 个月时也是如此。
