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

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.