AIM

The effect of laparoscopic surgery on sexual function in patients with ultra-low rectal cancer remains unexplored. This multicentre study evaluated postoperative sexual function in male patients with rectal cancer located within 5 cm of the anal verge.

METHOD

A total of 139 male patients aged ≤70 years with clinical T1-2N0M0 rectal cancer underwent laparoscopic surgery between January 2014 and March 2017 at 47 institutions. Sexual function was assessed using the International Index of Erectile Function (IIEF-15) and an ejaculation questionnaire preoperatively and at 3, 6, and 12 months postoperatively. Univariate and multivariate analyses were performed to examine risk factors for sexual dysfunction.

RESULTS

The IIEF-15 scores showed a significant decrease at 3 months postoperatively, with partial recovery observed at 12 months; however, the scores remained below baseline levels. Age ≥ 56 years was identified as a significant risk factor for postoperative erectile dysfunction. Although ejaculatory function exhibited some improvement over 12 months, it did not return to preoperative levels. However, the orgasmic function, sexual desire, and overall satisfaction domains recovered close to their preoperative levels.

CONCLUSION

Laparoscopic surgery for ultra-low rectal cancer significantly affects male sexual function, particularly in older patients. These findings highlight the necessity for thorough preoperative counselling and targeted postoperative management to address sexual dysfunction.