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Background <p>Sexual dysfunction (SD) is a recognized complication of rectal cancer surgery, even minimally invasive surgery (MIS), and can significantly impact postoperative quality of life. This study aimed to identify risk factors for SD and develop a predictive nomogram in a multicenter prospective setting.</p> Methods <p>This sub-analysis of the LANDMARC study initially enrolled 399 male patients who underwent laparoscopic (Lap) or robotic (Ro) rectal cancer surgery at 49 Japanese institutions between December 2019 and October 2022. After excluding patients who underwent transanal total mesorectal excision, total pelvic exenteration, prostate or seminal vesicle resection, surgical conversion, preoperative SD, or incomplete SD assessment, 300 patients were included in the final analysis. SD was defined as the presence of either erectile dysfunction or ejaculation dysfunction at 12&#xa0;months postoperatively based on patient-reported questionnaires.</p> Results <p>SD was observed in 129 (43.0%) patients. Multivariate analysis identified advanced age (odds ratio [OR]: 1.041; <i>p</i> = 0.01) and the Lap approach (compared with Ro surgery; OR: 1.795; <i>p</i> = 0.02) as independent risk factors for SD. A nomogram was constructed using variables selected by Least Absolute Shrinkage and Selection Operator regression. The model demonstrated modest discriminative ability (area under the curve: 0.672) with reasonable calibration in the intermediate-risk group.</p> Conclusions <p>Advanced age and Lap surgery were associated with an increased risk of postoperative SD after MIS for rectal cancer. Therefore, Ro surgery may offer protective advantages. Although the predictive accuracy of the nomogram was limited, it may aid preoperative counseling and raise awareness of postoperative sexual outcomes.</p>

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Risk factors for male sexual dysfunction after minimally invasive surgery for rectal cancer: a multicenter prospective subanalysis of the LANDMARC study

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Tsubasa Sakurai,
  • Tomohiro Yamaguchi,
  • Masakatsu Numata,
  • Takashi Sakamoto,
  • Koya Hida,
  • Tomonori Akagi,
  • Akio Shiomi,
  • Ryo Inada,
  • Manabu Shiozawa,
  • Keisuke Kazama,
  • Masanori Hotchi,
  • Daisuke Yamamoto,
  • Suguru Hasegawa,
  • Masashi Miguchi,
  • Shinobu Ohnuma,
  • Kay Uehara,
  • Koji Munakata,
  • Hisanaga Horie,
  • Toru Miyake,
  • Hiroki Takahashi,
  • Akinobu Furutani,
  • Shuichiro Matoba,
  • Kazuhiro Sakamoto,
  • Hiroyasu Kagawa,
  • Yusuke Kinugasa,
  • Shigeki Yamaguchi,
  • Masahiko Watanabe,
  • Takeshi Naitoh,
  • Akihiro Kondo,
  • Akio Higuchi,
  • Akira Komono,
  • Akiyoshi Kanazawa,
  • Arika Ida,
  • Atsushi Ishibe,
  • Atsushi Kamiyama,
  • Atsushi Ogura,
  • Daibo Kojima,
  • Gumpei Yoshimatsu,
  • Hideki Nagano,
  • Hideki Osawa,
  • Hiroaki Takeshita,
  • Hironao Okamoto,
  • Hiroya Kuroyanagi,
  • Hiroyuki Mushiake,
  • Hisashi Nagahara,
  • Hitoshi Hino,
  • Katsuya Osone,
  • Keigo Yokoi,
  • Keitaro Tanaka,
  • Ken Okamoto,
  • Kenji Kawada,
  • Kenji Kobayashi,
  • Kenta Iguchi,
  • Kodai Nagakari,
  • Koji Koinuma,
  • Koji Numata,
  • Koji Okabayashi,
  • Kumpei Honjo,
  • Makoto Takahashi,
  • Marie Hanaoka,
  • Masahiro Asari,
  • Masashi Ueno,
  • Masatsugu Kojima,
  • Masatsune Shibutani,
  • Masayoshi Obatake,
  • Miya Watanabe,
  • Nobuaki Hoshino,
  • Nobuhiro Sugano,
  • Nobuki Ichikawa,
  • Noriko Iwata,
  • Ryo Ohno,
  • Ryuichi Oshima,
  • Shigeo Ninomiya,
  • Shinichi Yamauchi,
  • Shintaro Akamoto,
  • Shoichi Manabe,
  • Shuji Saito,
  • Suguru Nukada,
  • Taiki Kajiwara,
  • Takahisa Hirokawa,
  • Takamasa Yamamoto,
  • Takao Takahashi,
  • Takashi Ueki,
  • Takuhisa Okada,
  • Takuya Miura,
  • Takuya Suzuki,
  • Taro Munachika,
  • Tatsuya Kinjo,
  • Teni Godai,
  • Tomoaki Okada,
  • Tomohisa Furuhata,
  • Tomomichi Kiyomatsu,
  • Toshiki Mukai,
  • Toshiya Nagasaki,
  • Yasumitsu Hirano,
  • Yo Mikayama,
  • Yohei Kurose,
  • Yoshihito Ide,
  • Yoshiko Matsumoto,
  • Yosuke Fukunaga,
  • Yu Okazawa,
  • Yudai Fukui,
  • Yujiro Kokado,
  • Yuki Nishihara,
  • Yukiharu Hiyoshi,
  • Yusuke Kikuchi,
  • Yusuke Yamaoka

摘要

Background

Sexual dysfunction (SD) is a recognized complication of rectal cancer surgery, even minimally invasive surgery (MIS), and can significantly impact postoperative quality of life. This study aimed to identify risk factors for SD and develop a predictive nomogram in a multicenter prospective setting.

Methods

This sub-analysis of the LANDMARC study initially enrolled 399 male patients who underwent laparoscopic (Lap) or robotic (Ro) rectal cancer surgery at 49 Japanese institutions between December 2019 and October 2022. After excluding patients who underwent transanal total mesorectal excision, total pelvic exenteration, prostate or seminal vesicle resection, surgical conversion, preoperative SD, or incomplete SD assessment, 300 patients were included in the final analysis. SD was defined as the presence of either erectile dysfunction or ejaculation dysfunction at 12 months postoperatively based on patient-reported questionnaires.

Results

SD was observed in 129 (43.0%) patients. Multivariate analysis identified advanced age (odds ratio [OR]: 1.041; p = 0.01) and the Lap approach (compared with Ro surgery; OR: 1.795; p = 0.02) as independent risk factors for SD. A nomogram was constructed using variables selected by Least Absolute Shrinkage and Selection Operator regression. The model demonstrated modest discriminative ability (area under the curve: 0.672) with reasonable calibration in the intermediate-risk group.

Conclusions

Advanced age and Lap surgery were associated with an increased risk of postoperative SD after MIS for rectal cancer. Therefore, Ro surgery may offer protective advantages. Although the predictive accuracy of the nomogram was limited, it may aid preoperative counseling and raise awareness of postoperative sexual outcomes.