INTRODUCTION: Over the last decades outcomes for rectal cancer surgery have improved, with increasing survival rates. Nevertheless, functional disorders are still frequent. AIM: To evaluate sexual and urinary outcomes of miniinvasive total mesorectal excision (TME). MATERIAL AND METHODS: Between March 2016 and June 2018 patients with rectal cancer who underwent miniinvasive TME with a sphincter-saving procedure were enrolled. The questionnaires were completed before therapy, and 6, 12, and 24 months after stoma closure. We used the Female Sexual Function Index (FSFI), the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function questionnaire (IIEF). RESULTS: Ninety-eight patients completed the questionnaires. Only patients who underwent laparoscopic (39) or robotic TME (27) were enrolled. The characteristics and surgical outcomes did not differ significantly between these groups. The IPSS between the groups was comparable before and after the operation with no significant difference, increased at 6 months and then decreased consecutively. In comparison with baseline, IPSS was significantly lower in the laparoscopic and robotic groups at 6 months and was comparable to baseline at 24 months in both groups. Oppositely, the IIEF was significantly lower at 6 months after ileostomy closure in the robotic group (p < 0.05), but not in the laparoscopic group (p = 0.59) and both returned to baseline at 24 months. FSFI was significantly lower in the laparoscopic group (p = 0.017) 6 months after surgery and returned to baseline at 24 months in both groups. CONCLUSIONS: Laparoscopic and robotic TME showed similar functional results 2 years after stoma resection.

Department of Biology Faculty of Education Trnava University Trnava Slovakia

Department of Surgery Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Department of Surgery Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Surgery Hospital Novy Jicin Novy Jicin Czech Republic

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Ridolfi TM, Berger N, Ludwig KA. Low anterior resection syndrome: current management and future directions. Clin Colon Rectal Surg 2016; 29: 239-45. PubMed PMC

Baik SH, Kang CM, Lee WJ, et al. . Robotic total mesorectal excision for the treatment of rectal cancer. J Robot Surg 2007; 1: 99-102. PubMed PMC

Traa MJ, De Vries J, Roukema JA, Den Oudsten BL. Sexual (dys) function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 2012; 23: 19-27. PubMed

Moore HG, Riedel E, Minsky BD, et al. . Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol 2003; 10: 80-5. PubMed

Patriti A, Ceccarelli G, Bartoli A, et al. . Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. J Soc Laparoendosc Surg 2009; 13: 176-83. PubMed PMC

Katsuno H, Hanai T, Masumori K, et al. . robotic surgery for rectal cancer: operative technique and review of the literature. J Anus Rectum Colon 2020; 4: 14-24. PubMed PMC

Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M, Glimelius B, et al. . Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997; 336: 980-7. PubMed

Kowalewski KF, Seifert L, Ali S, et al. . Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis. Surg Endosc 2021; 35: 81-95. PubMed PMC

Peltrini R, Luglio G, Cassese G, et al. . Oncological outcomes and quality of life after rectal cancer surgery. Open Med 2019; 14: 653-62. PubMed PMC

Chew MH, Yeh YT, Lim E, Seow-Choen F. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep 2016; 4: 173-85. PubMed PMC

Bianchi PP, Ceriani C, Locatelli A, et al. . Robotic versus laparoscopic total mesorectal excision: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc 2010; 24: 2888-94. PubMed

Pontallier A, Denost Q, Van Geluwe B, et al. . Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc 2016; 30: 4924-33. PubMed

Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 2005; 31: 1-20. PubMed

Kim NK, Kim YW, Cho MS. Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: expert technical tips for robotic surgery. Surg Oncol 2015; 24: 172-80. PubMed

Bisett IP, Zarkovic A, Hamilton P, et al. . Localisation of hypogastric nerves and plevic plexus in relation to rectal cancer surgery. Eur J Anat 2007; 11: 111-8.

Moszkowicz D, Alsaid B, Bessede T, et al. . Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis 2011; 13: 1326-34. PubMed

Aziz O, Constantinides V, Tekkis PP, et al. . Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 2006; 13: 413-24. PubMed

Gao F, Cao YF, Chen LS. Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer. Int J Colorectal Dis 2006; 21: 652-6. PubMed

Huang MJ, Liang JL, Wang H, et al. . Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis 2011; 26: 415-21. PubMed

Penninckx F, Kartheuser A, Van de Stadt J, et al. .; PROCARE . Outcome following laparoscopic and open total mesorectal excision for rectal cancer. Br J Surg 2013; 100: 1368-75. PubMed

Quah HM, Jayne DG, Eu KW, Seow-Choen F. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 2002; 89: 1551-6. PubMed

Luca F, Craigg DK, Senthil M, et al. . Sexual and urinary outcomes in robotic rectal surgery: review of the literature and technical considerations. Updates Surg 2018; 70: 415-21. PubMed

Tejedor P, Sagias F, Flashman K, et al. . The impact of robotic total mesorectal excision on survival of patients with rectal cancer – a propensity matched analysis. Int J Colorectal Dis 2019; 34: 2081-9. PubMed

Sebastián-Tomás JC, Santarrufina-Martínez S, Navarro-Martínez S, et al. . Robotic total mesorectal excision: state of the art. Miniinv Surg 2019; 3: 30.

Tang X, Wang Z, Wu X, et al. . Robotic versus laparoscopic surgery for rectal cancer in male urogenital function preservation, a meta-analysis. World J Surg Oncol 2018; 16: 196. PubMed PMC

D’Annibale A, Pernazza G, Monsellato I, et al. . Total mesorectal excision: a comparison of oncological and functional outcomes between robotic and laparoscopic surgery for rectal cancer. Surg Endosc 2013; 27: 1887-95. PubMed

Kim HJ, Choi GS, Park JS, et al. . The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis 2018; 20: O103-13. PubMed

Park SY, Choi GS, Park JS, et al. . Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison. World J Surg 2014; 38: 1834-42. PubMed

Luca F, Valvo M, Ghezzi TL, et al. . Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 2013; 257: 672-8. PubMed

Morelli L, Ceccarelli C, Di Franco G, et al. . Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis 2016; 31: 913-5. PubMed

Panteleimonitis S, Ahmed J, Harper M, Parvaiz A. Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery. World J Gastrointest Surg 2016; 8: 744-54. PubMed PMC

Jayne D, Pigazzi A, Marshall H, et al. . Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR RCT. JAMA 2017; 318: 1569-80. PubMed PMC

Del Río C, Sánchez-Santos R, Oreja V, et al. . Long-term urinary dysfunction after rectal cancer surgery. Colorectal Dis 2004; 6: 198-202. PubMed

Pontallier A, Denost Q, Van Geluwe B, et al. . Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Surg Endosc 2016; 30: 4924-33. PubMed

Sun Y, Lian L, Zhang H, et al. . The feasibility and technical strategy of a fascia space priority approach in laparoscopic lateral lymph node dissection for advanced middle and low rectal cancer: a retrospective multicentre study. Videosurgery 2021; 16: 312-20. PubMed PMC

da Silva GM, Hull T, Roberts PL, et al. . The effect of colorectal surgery in female sexual function, body image, self-esteem and general health: a prospective study. Ann Surg 2008; 248: 266-72. PubMed