Erectile dysfunction common within the first year after rectal cancer surgery

Abstract

Colorectal cancer studies commonly use broad “umbrella” terms when discussing the outcomes of rectal cancer surgery and fail to ferret out the prevalence of the individual side effects. A study from Denmark has investigated the prevalence of erectile dysfunction (ED) 1 year after rectal cancer surgery, especially because survival rates for patients with rectal cancer have increased substantially on account of improvements in surgical, oncological, perioperative, and chemotherapy care.

However, this also has led to a growing risk of postsurgical complications, noted the study authors. For example, resection of the rectum can cause intraoperative nerve damage to the pelvic plexus nerves, which is believed to be the leading cause of postoperative sexual dysfunction.

The study appears in the European Journal of Surgical Oncology (doi:10.1016/j.ejso.2024.108662).

According to the lead study author, Sebastian B. Hansen, PhD, who works at the Center for Perioperative Optimization in the Department of Surgery at the Copenhagen University Hospital in Denmark, the primary objective of this systematic review was to estimate the prevalence of ED within the first year after surgery for rectal cancer.

The second objective, Dr Hansen says, was to assess to what extent the surgical approach and techniques, including chemotherapy and radiotherapy, affected the occurrence of ED. “We wanted to investigate if the risk of developing sexual dysfunction following rectal cancer treatment was substantial, and if so, what contributed to it.” He adds that they were aware that the disease itself might contribute to the risk of sexual function impairment.

The researchers believe that their data overall are valid, even though the prevalence of moderate to severe ED varied between different studies. As a result, they are confident that “a great number of recovering rectal cancer patients are at risk.”

The overall confidence levels were low because even though the initial search resulted in 74 studies, only 22 studies were included in the analysis, as noted previously. The researchers wrote that this was due to “shortcomings” in the data reporting. For example, they noted that even though most of the studies used the 5- and 15-item versions of the International Index of Erectile Function, which allows for the stratification of ED degrees on a point score, the bulk of the studies reported only the mean or median results. They believe that this minimized their ability to gauge the level and intensity of ED. “The degree of ED is important since rectal cancer usually affects older men who (already) might have some deterioration in ED function at the time of diagnosis (and not an after effect from surgery),” they said.

Another key finding from the study was that overall, no significant difference was found with respect to the time of follow-up during the first year. However, the researchers speculate that a reason for the lower incidences of ED in patients who underwent robot-assisted surgery and had better slightly outcomes was the technique.

They said that it is important to note two other things. First, they eliminated less severe cases of ED and focused on moderate to severe instances; this may have led to an underestimation of the level of ED. Second, most of the studies included only sexually active men. “However, men can still have ED without being sexually active, and thus patients should not be excluded solely for this reason,” they said.

“We believe this is the largest review on the topic of ED following surgery for rectal cancer,” says Dr Hansen. “It provides clinicians some statistics with regards to ED as a postoperative complication, namely how often it occurs. I believe this is important when giving an informed consent when undergoing surgery.”

“This study doesn’t necessarily cover new ground,” says Robert Krouse, MD, a professor of surgery at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “But it does add precision for what we know. In addition, the fact that things do not improve is extremely important. I’m unaware if that’s been found in other publications.”

Dr Krouse adds, “This information likely will not lead to changes in decision-making but may help long-term cancer survivorship planning and treatment.”

Dr Krouse says that the takeaway message for cancer clinicians and researchers is to note or remember that “one third of male rectal cancer patients have significant ED after treatments that is likely to be long-lasting or permanent.”

Dr Hansen says that this study should serve as a reminder to surgeons performing colorectal cancer surgery that ED is a common late complication. Surgeons should ask their patients preoperatively as well as postoperatively about this matter because it might be important for the patients.

“A patient might not see the relation between rectal surgery and ED, and thus it is the surgeon’s job to provide this information.”