Effect of open versus 3D laparoscopic surgery for rectal cancer on male urinary and sexual function

doi:10.3877/cma.j.issn.1674-0785.2019.04.002

Abstract

Abstract:

Objective

To prospectively assess the sexual and urinary functions as well as factors influencing these functions in patients undergoing open or 3D laparoscopic surgery for rectal cancer.

Methods

A retrospective analysis was performed of the clinical data of 37 male rectal cancer patients treated at Shougang Hospital, Peking University from January 2015 to October 2016. Their sexual and urinary functions were assessed through self-administered questionnaires comprising the International Index of Erectile Function (IIEF; sexual function) and the International Prostate Symptom Score (IPSS; urinary function) before and 3, 6, and 12 months after surgery. Age, body mass index (BMI), operation time, and blood loss were compared between the two groups by the t-test. Tumor TNM stage, tumor location, N stage, T stage, surgical procedure, complications, and chemotherapy were compared by the chi-square test. The influence of each of these observation factors on IIEF and IPSS scores was analyzed by the rank sum test. The influencing factors on IIEF and IPSS scores at 12 months after operation were analyzed by multiple linear regression.

Results

Fifteen patients who underwent 3D laparoscopic surgery and 22 patients who underwent open surgery were finally analyzed in this study. There were no significant differences in age, BMI, TNM stage, N stage, T stage, surgical procedure, complications, or chemotherapy between the two groups (P>0.05). The operation time of the 3D laparoscopic operation group was significantly longer than that of the traditional open surgery group [(222.67±41.40) min vs (159.36±21.26) min, F=6.414, P<0.05]. The amount of bleeding in the 3D laparoscopic rectal cancer operation group was significantly lower than that in the traditional open surgery group [(375.45±252.20) ml vs (161.33±165.57) ml, F=2.654, P<0.05]. The IIEF scores of patients with low tumor location were significantly lower than those of patients with high tumor location at 3, 6, and 12 months after operation (Z=-3.698, -3.445, -3.668, P<0.05). The IIEF scores of patients with intraoperative blood loss>500 ml during operation decreased significantly at 3, 6, and 12 months after operation (Z=-2.785, -2.644, -2.538, P<0.05). The IPSS scores of the elderly group were significantly higher than those of the younger group at 3, 6, and 12 months (H=15.810, 17.926, 18.162, P<0.05). The IPSS score of patients with low tumor location was significantly higher than that of patients with high tumor location (Z=-0.268, P=0.045) at 3 months after operation. Multiple linear regression analysis showed that age, tumor location, and blood loss were correlated with sexual function at 12 months after operation (P=0.039, 0.001, 0.019). Age was a risk factor for urinary function at 12 months after operation (P<0.05).

Conclusions

The type of surgery is not a risk factor affecting sexual function and urinary function. Age, tumor location, and blood loss are risk factors for sexual dysfunction, while age is a risk factor for urinary dysfunction.

Key words: 3D laparoscopic surgery, Rectal cancer, Sexual function, Urinary function

Qingkun Gao, Pengfei Niu, Yanzhao Wang, Zhaoya Gao, Wensheng Huang, Fuming Lei, Jin Gu. Effect of open versus 3D laparoscopic surgery for rectal cancer on male urinary and sexual function[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(04): 246-253.

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Figures/Tables 6

References 19

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组别	例数	年龄（岁，±s）	体质量指数（kg/m²，±s）	TNM分期		肿瘤位置		淋巴结转移		T分期
组别	例数	年龄（岁，±s）	体质量指数（kg/m²，±s）	Ⅰ	Ⅱ~Ⅲ	高位	低位	否	是	T₁	T₂–T₄
传统开腹组	22	59.14±10.21	22.64±4.24	0	21	8	14	14	8	4	18
3D腹腔镜组	15	60.93±6.43	23.13±3.82	1	15	5	10	9	6	7	8
统计值	?	t=-0.656	t=0.354	χ²=1.657		χ²=0.036		χ²=0.050		χ²=1.130
P值	?	0.516	0.725	0.437		0.805		0.823		0.568

组别	例数	年龄（岁，±s）	体质量指数（kg/m²，±s）	TNM分期		肿瘤位置		淋巴结转移		T分期
组别	例数	年龄（岁，±s）	体质量指数（kg/m²，±s）	Ⅰ	Ⅱ~Ⅲ	高位	低位	否	是	T₁	T₂–T₄
传统开腹组	22	59.14±10.21	22.64±4.24	0	21	8	14	14	8	4	18
3D腹腔镜组	15	60.93±6.43	23.13±3.82	1	15	5	10	9	6	7	8
统计值	?	t=-0.656	t=0.354	χ²=1.657		χ²=0.036		χ²=0.050		χ²=1.130
P值	?	0.516	0.725	0.437		0.805		0.823		0.568

组别	例数	术式（例）			手术时间（min，±s）	失血量（ml，±s）	并发症（例）			辅助化疗（例）
组别	例数	LAR	Hartmann	APR	手术时间（min，±s）	失血量（ml，±s）	肠梗阻	吻合口瘘	其他	辅助化疗（例）
传统开腹组	22	18	1	3	159.36±21.26	375.45±252.20	2	1	3	16
3D腹腔镜组	15	15	0	0	222.67±41.40	161.33±165.57	1	0	1	7
统计值	?	χ²=3.058			t=-5.452	t=2.885	χ²=0.700	χ²=0.701	χ²=0.449	χ²=2.575
P值	?	0.217			<0.05	0.007	0.791	0.403	0.503	0.109

组别	例数	术式（例）			手术时间（min，±s）	失血量（ml，±s）	并发症（例）			辅助化疗（例）
组别	例数	LAR	Hartmann	APR	手术时间（min，±s）	失血量（ml，±s）	肠梗阻	吻合口瘘	其他	辅助化疗（例）
传统开腹组	22	18	1	3	159.36±21.26	375.45±252.20	2	1	3	16
3D腹腔镜组	15	15	0	0	222.67±41.40	161.33±165.57	1	0	1	7
统计值	?	χ²=3.058			t=-5.452	t=2.885	χ²=0.700	χ²=0.701	χ²=0.449	χ²=2.575
P值	?	0.217			<0.05	0.007	0.791	0.403	0.503	0.109

指标		例数	术前	术后3个月	术后6个月	术后12个月
手术类型		?	?	?	?	?
?	开腹	22	44.00（33.00~50.25）	23.50（14.25~40.00）	28.00（19.00~42.00）	29.00（22.75~44.25）
?	3D腹腔镜	15	48.00（33.00~53.00）	32.00（25.00~45.00）	36.00（28.00~45.00）	38.00（32.00~46.00）
Z值		?	-0.743	-1.891	-1.908	-1.923
P值		?	0.472	0.061	0.056	0.056
年龄（岁）		?	?	?	?	?
?	<50	6	52.00（46.00~61.00）	29.00（14.25~42.00）	30.50（18.75~43.00）	33.50（22.00~45.00）
?	50~69	27	44.00（38.00~50.00）	32.00（23.00~43.00）	35.00（28.00~44.00）	38.00（28.00~46.00）
?	≥70	4	15.50（10.25~44.00）	8.50（8.00~35.25）	9.00（9.00~36.75）	9.00（8.25~36.75）
H值		?	7.397	3.277	3.270	4.239
P值		?	0.025	0.194	0.195	0.120
肿瘤位置		?	?	?	?	?
?	高位	13	48.00（44.50~50.50）	43.00（39.50~45.00）	44.00（41.00~45.50）	46.00（43.00~47.00）
?	低位	24	40.00（30.50~52.75）	23.50（13.00~31.50）	28.00（20.00~34.75）	29.00（23.25~37.50）
Z值		?	-1.210	-3.698	-3.445	-3.668
P值		?	0.236	0.000	0.000	0.000
术式		?	?	?	?	?
?	LAR	33	46.00（35.50~52.50）	32.00（19.50~43.00）	35.00（22.00~44.50）	38.00（25.50~46.00）
?	Hartmann	1	40.00（40.00~40.00）	24.00（24.00~24.00）	28.00（28.00~28.00）	28.00（28.00~28.00）
?	APR	3	34.00（20.00~47.00）	16.00（8.00~42.00）	20.00（9.00~44.00）	24.00（8.00~45.00）
H值		?	1.834	1.348	1.350	1.760
P值		?	0.400	0.510	0.509	0.415
淋巴结转移		?	?	?	?	?
?	否	23	44.00（33.00~53.00）	26.00（19.00~42.00）	29.00（21.00~44.00）	32.00（24.00~45.00）
?	是	14	47.00（36.50~51.25）	34.00（11.25~43.25）	36.50（20.25~44.50）	39.50（24.25~46.25）
Z值		?	-0.141	-0.330	-0.502	-0.659
P值		?	0.889	0.745	0.632	0.526
肿瘤T分期		?	?	?	?	?
?	T₁	9	46.00（18.50~49.00）	34.00（10.50~41.50）	36.00（15.50~43.00）	38.00（17.50~46.00）
?	T₂	6	50.50（43.00~56.25）	39.50（20.25~45.00）	41.50（24.75~46.00）	44.00（25.75~48.00）
?	T₃	22	44.00（32.75~53.00）	25.50（18.75~41.25）	28.50（20.75~42.50）	32.00（24.00~45.00）
H值		?	2.937	1.765	2.067	2.045
P值		?	0.230	0.414	0.356	0.360
体质量指数（kg/m²）		?	?	?	?	?
?	<25	29	45.00（38.50~51.50）	34.00（20.50~43.00）	35.00（22.00~44.50）	38.00（26.00~46.00）
?	≥25	8	40.00（13.50~53.75）	17.00（9.00~37.25）	21.50（9.50~39.75）	26.00（11.50~41.25）
Z值		?	-0.683	-1.497	-1.646	-1.572
P值		?	0.502	0.137	0.101	0.118
失血量（ml）		?	?	?	?	?
?	<500	28	44.50（34.25~50.75）	36.50（23.25~43.75）	39.00（28.00~45.00）	42.00（28.50~46.00）
?	≥500	9	47.00（27.50~57.50）	16.00（8.50~27.00）	20.00（13.00~30.50）	25.00（19.50~32.00）
Z值		?	-0.585	-2.785	-2.644	-2.538
P值		?	0.566	0.004	0.007	0.010
并发症		?	?	?	?	?
?	是	8	45.00（29.50~53.75）	34.00（9.75~39.75）	36.00（16.75~41.75）	39.50（20.75~42.25）
?	否	29	45.00（33.50~53.75）	26.00（19.50~43.00）	33.00（21.50~44.50）	33.00（24.50~46.00）
Z值		?	0.000	-0.296	-0.259	-0.037
P值		?	1.000	0.786	0.814	0.986
辅助化疗		?	?	?	?	?
?	是	23	46.00（26.00~51.00）	26.00（9.00~41.00）	34.00（16.00~42.00）	36.00（22.00~45.00）
?	否	14	44.50（37.50~53.00）	34.50（23.75~44.25）	37.00（28.00~45.00）	38.00（30.75~46.00）
Z值		?	-0.502	-1.569	-1.319	-1.130
P值		?	0.632	0.122	0.196	0.270

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