Initial experience on the urogenital outcomes after robotic rectal cancer surgery

Aim Despite improvement in surgical approach and technology, total mesorectal excision for low rectal cancer has been associated with significant postoperative sexual and urinary dysfunction. We hypothesize that robot-assisted laparoscopic total mesorectal excision can achieve maintenance of such functions by its more assured pelvic splanchnic nerve preservation. Patients and Methods We prospectively assessed the preoperative and postoperative sexual and urinary function of male patients who received robot-assisted laparoscopic total mesorectal excision for rectal cancer since May 2009. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) were employed for the assessment. The baseline and the 3-month postoperative assessments of sexual and urinary function were analyzed and compared. Results In a 34-month period, 33 male patients underwent robotic-assisted rectal surgery. Their median age was 64 years (range: 33–84). Twenty-six patients underwent sphincter-saving total mesorectal excision, and four patients underwent neoadjuvant chemo-irradiation. At 3 months' postoperative, one patient (3 per cent) still failed to produce spontaneous voiding. He was treated by long-term Foley catheterization. The mean baseline and 3 months' postoperative IPSS scores were 4 and 4.1, respectively. There was no significant difference in IPSS score after operation. Fifteen patients (45.5 per cent) were sexually active before their operation. The mean baseline and 3 months' postoperative IIEF-5 scores were 20 and 9.4, respectively. There was no significant difference in the IIEF-5 score before and after the operation. Overall, there was a trend towards worsening erectile function after surgery. Conclusion Preliminary data from this study suggest that the robot-assisted technique does not confer additional benefits in the preservation of urogenital function when compared to conventional laparoscopic technique. Further large-scale studies are warranted to validate the role of the robot-assisted technique in rectal cancer surgery.