Impact of Abdominoperineal Resection on Postoperative Male Sexual Function After Minimally Invasive Rectal Cancer Surgery: A Subgroup Analysis From the LANDMARC Study.

AIM: Using data from the LANDMARC study, we aimed to evaluate the impacts of abdominoperineal resection (APR) on postoperative sexual function in males with rectal cancer undergoing minimally invasive surgery.

METHODS

Patients were categorized into the APR (n = 44) and anal-sparing surgery (AS) groups (n = 329). A detailed subgroup analysis was performed in patients with tumors located < 5 cm from the anal verge (APR, n = 39; AS, n = 59). Sexual function was assessed preoperatively and at 3, 6, and 12 months postoperatively using the International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS), and a customized questionnaire for ejaculatory function. Propensity score-based logistic regression models and longitudinal analyses were applied to address significant baseline imbalances.

RESULTS

In the overall cohort, APR was independently associated with significantly impaired erectile function. Adjusted models showed higher predicted probabilities of erectile dysfunction (ErD) after APR at 3 months (38.7% vs. 16.8) and 12 months (34.7% vs. 13.7%). Longitudinal analyses confirmed increased odds of ErD at 3 months (OR 2.86; 95% CI 1.25-6.53) and 12 months (OR 3.05; 95% CI 1.30-7.14). Potency impairment was also significantly more frequent at 3 months. Ejaculatory dysfunction was more common after APR early postoperatively. In patients with tumors located < 5 cm from the anal verge, APR remained associated with impaired erectile function, whereas ejaculatory function showed partial recovery.

CONCLUSION

Results suggest that APR is associated with a high risk of postoperative sexual dysfunction, even in minimally invasive surgery. Sexual function preservation is an important consideration when APR is considered.