Title : Urogenital outcomes following laparoscopic and robotic assisted rectal cancer resection - A prospective longitudinal study
Abstract:
Purpose: Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery.
Methods: Urological and sexual functions were assessed using gender-specific validated standardized questionnaires. Urinary and erectile function were evaluated using the International Prostatic Symptom Score (IPSS) and the five-item version of the International Index of Erectile Function (IIEF-5) scale and female sexual function by female sexual function index (FSFI). A total of 62 patients of whom 21(Female 4, Male 17) underwent laparoscopic and 41 (Female10, Male 21) robotic surgery. Data were prospectively collected from the two groups at baseline,3, and 6 months after surgery and compared.
Results: The mean IPSS score was similar between the two groups at baseline and 3 months, but it was lower in the robotic arm at 6 months (laparoscopic- 7.39±4.27, robotic- 6.48±4.33 p=0.43) though not significant. The interval decreases in scores at 6 months favoured the robotic arm (laparoscopic- 2.07±3.82, robotic- 1.33±3.25 p=0.45). The mean baseline IIEF-5 score was slightly better in the robotic cohort (laparoscopic- 22.58±2.93, robotic- 23.62±1.8 p=0.25). The interval decrease in IIEF-5 scores at 6 months was higher in the laparoscopic group than in the robotic group at 6 months (laparoscopic= -4.65±4.82, robotic= -5±4.76 p=0.83). The mean FSFI score at baseline was better in the robotic group, but the interval decrease was similar between both the groups (laparoscopic=-1.38±1.12, robotic= -1.2±1.13 p=0.85).
Conclusion: Evaluating quality of life and functional outcomes can help patients and surgeons make decisions by giving them a thorough grasp of the results of surgical techniques, such as robotic or laparoscopic procedures. In conclusion, the postoperative sexual and urinary functions were comparable between patients who underwent laparoscopic and those who underwent robotic rectal surgery, although there was trend towards laparoscopic approach in male urinary function and towards robotic for better recovery of male and female sexual function in this non-randomized comparison. Age, RT, Stoma, lower rectal tumour and APR negatively corelated with urogenital function. Therefore, while we consider this study to be a significant step in comparing the relative efficacy of RTME and LTME as treatment options for clinically localized rectal cancer, larger, well-designed comparisons based on randomized controlled trials are necessary to more definitively assess RTME against alternative treatment modalities.
