Gaffney Christopher D, Punjani Nahid, Brant Aaron, Fainberg Jonathan, Voleti Sandeep Sai, Zheng Xinyan, Sedrakyan Art, Garrett Kelly A, Kashanian James A
Department of Urology, Weill Cornell Medicine, New York, NY, USA.
Department of Urology, Mayo Clinic, Phoenix, AZ, USA.
Updates Surg. 2024 Dec;76(8):2787-2794. doi: 10.1007/s13304-024-02005-z. Epub 2024 Nov 20.
To explore the frequency and predictive factors of erectile dysfunction diagnosis after colorectal cancer surgery. The Surveillance, Epidemiology, and End Results-Medicare database was used to identify a national sample of men undergoing surgery for colorectal cancer from 2004 to 2015. Men aged > 65 years with any index surgery within 1 year of diagnosis of colorectal cancer were included. Men with a history of prior erectile dysfunction, metastatic cancer, or genitourinary cancer prior to their index procedure were excluded. The primary outcome was a new diagnosis of erectile dysfunction within 2 years of the index procedure. A total of 28,248 men aged > 65 years who underwent colorectal cancer surgery were identified. The rates of erectile dysfunction diagnosis 2 years after surgery were 3.6% for hemicolectomy, 5.3% for low anterior resection, and 6.4% for abdominoperineal resection. On multivariable analysis, low anterior resection (HR: 1.27, 95%CI 1.08 to 1.51, p < 0.01) and abdominoperineal resection (HR: 1.49, 95%CI 1.14 - 1.93, p < 0.01) were independently associated with increased risk of erectile dysfunction compared to hemicolectomy. Minimally invasive surgery was independently associated with an increased risk of erectile dysfunction compared to open surgery (HR: 1.44, 95% CI 1.25-1.65, p < 0.001). Compared to hemicolectomy, men treated with low anterior resection and abdominoperineal resection have a higher risk of being diagnosed with erectile dysfunction within 2 years of treatment. The absolute rate of erectile dysfunction diagnosis was low compared to rates reported in prior controlled trials, suggesting that patients are underdiagnosed in real-world settings.
探讨结直肠癌手术后勃起功能障碍诊断的频率及预测因素。利用监测、流行病学和最终结果-医疗保险数据库，确定了2004年至2015年期间接受结直肠癌手术的全国男性样本。纳入年龄>65岁、在结直肠癌诊断后1年内进行任何索引手术的男性。排除在索引手术前有勃起功能障碍、转移性癌症或泌尿生殖系统癌症病史的男性。主要结局是索引手术后2年内新诊断出勃起功能障碍。共识别出28248名年龄>65岁接受结直肠癌手术的男性。手术后2年勃起功能障碍的诊断率，半结肠切除术为3.6%，低位前切除术为5.3%，腹会阴联合切除术为6.4%。多变量分析显示，与半结肠切除术相比，低位前切除术（HR：1.27，95%CI 1.08至1.51，p<0.01）和腹会阴联合切除术（HR：1.49，95%CI 1.14 - 1.93，p<0.01）与勃起功能障碍风险增加独立相关。与开放手术相比，微创手术与勃起功能障碍风险增加独立相关（HR：1.44，95%CI 1.25 - 1.65，p<0.001）。与半结肠切除术相比，接受低位前切除术和腹会阴联合切除术治疗的男性在治疗后2年内被诊断为勃起功能障碍的风险更高。与先前对照试验报告的发生率相比，勃起功能障碍的绝对诊断率较低，这表明在现实环境中患者的诊断不足。
