{"title":"关于直肠癌腹腔镜、机器人和经肛门手术后男性性功能障碍的前瞻性多中心综合调查(LANDMARC 研究)。","authors":"Masakatsu Numata, Tomohiro Yamaguchi, Akio Shiomi, Ryo Inada, Manabu Shiozawa, Keisuke Kazama, Masanori Hotchi, Daisuke Yamamoto, Suguru Hasegawa, Masashi Miguchi, Shinobu Ohnuma, Kay Uehara, Koji Munakata, Yusuke Kinugasa, Hisanaga Horie, Shigeki Yamaguchi, Teppei Takeshima, Koya Hida, Tomonori Akagi, Hiroyasu Kagawa, Shunsuke Oyamada, Yasushi Rino, Yoshiharu Sakai, Masahiko Watanabe, Takeshi Naitoh","doi":"10.1097/SLA.0000000000006574","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To investigate the incidence of male sexual dysfunction (SD) including erectile dysfunction (ErD) and ejaculatory dysfunction (EjD) after minimally invasive rectal cancer surgery.</p><p><strong>Background: </strong>Male SD significantly affects post-rectal cancer surgery quality of life (QOL). Current assessments using the International Index of Erectile Function-5 are unsuitable for patients with reduced postoperative sexual activity, because it assumes sexual intercourse. This study addresses this gap using the Erection Hardness Score (EHS) and custom ejaculatory questionnaires.</p><p><strong>Methods: </strong>This prospective multicenter open-label phase II trial enrolled 399 patients who underwent laparoscopic (Lap), robotic (Ro), or transanal (Ta) rectal cancer surgery. EHS and custom ejaculatory questionnaires assessed ErD, EjD, and potency impairment at 3, 6, and 12 months postoperatively. The rates were assessed in the full analysis set and compared between the Lap and Ro groups after propensity score matching.</p><p><strong>Results: </strong>At 12 months, the overall incidences of ErD and EjD were 34.7% and 29.8%, respectively. The Ro group showed a significantly lower EjD rate (25.0%) than the Lap group (40.9%), with no significant difference in ErD. Potency impairment was lower in the Ro group at 6 months (32.7% vs. 22.3%) and 12 months (29.0% vs. 17.8%) postoperatively. The Ta group showed relatively high ErD and EjD at 3 months, with some recovery at 12 months.</p><p><strong>Conclusions: </strong>Minimally invasive rectal cancer surgery commonly results in ErD, EjD, and potency impairment. Robotic surgery provides lower EjD rates and less potency impairment. Comprehensive sexual function assessments are essential to inform patients and improve QOL outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prospective Multicenter Comprehensive Survey on Male Sexual Dysfunction following Laparoscopic, Robotic, and Transanal Approaches for Rectal Cancer (the LANDMARC Study).\",\"authors\":\"Masakatsu Numata, Tomohiro Yamaguchi, Akio Shiomi, Ryo Inada, Manabu Shiozawa, Keisuke Kazama, Masanori Hotchi, Daisuke Yamamoto, Suguru Hasegawa, Masashi Miguchi, Shinobu Ohnuma, Kay Uehara, Koji Munakata, Yusuke Kinugasa, Hisanaga Horie, Shigeki Yamaguchi, Teppei Takeshima, Koya Hida, Tomonori Akagi, Hiroyasu Kagawa, Shunsuke Oyamada, Yasushi Rino, Yoshiharu Sakai, Masahiko Watanabe, Takeshi Naitoh\",\"doi\":\"10.1097/SLA.0000000000006574\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To investigate the incidence of male sexual dysfunction (SD) including erectile dysfunction (ErD) and ejaculatory dysfunction (EjD) after minimally invasive rectal cancer surgery.</p><p><strong>Background: </strong>Male SD significantly affects post-rectal cancer surgery quality of life (QOL). Current assessments using the International Index of Erectile Function-5 are unsuitable for patients with reduced postoperative sexual activity, because it assumes sexual intercourse. This study addresses this gap using the Erection Hardness Score (EHS) and custom ejaculatory questionnaires.</p><p><strong>Methods: </strong>This prospective multicenter open-label phase II trial enrolled 399 patients who underwent laparoscopic (Lap), robotic (Ro), or transanal (Ta) rectal cancer surgery. EHS and custom ejaculatory questionnaires assessed ErD, EjD, and potency impairment at 3, 6, and 12 months postoperatively. The rates were assessed in the full analysis set and compared between the Lap and Ro groups after propensity score matching.</p><p><strong>Results: </strong>At 12 months, the overall incidences of ErD and EjD were 34.7% and 29.8%, respectively. The Ro group showed a significantly lower EjD rate (25.0%) than the Lap group (40.9%), with no significant difference in ErD. Potency impairment was lower in the Ro group at 6 months (32.7% vs. 22.3%) and 12 months (29.0% vs. 17.8%) postoperatively. The Ta group showed relatively high ErD and EjD at 3 months, with some recovery at 12 months.</p><p><strong>Conclusions: </strong>Minimally invasive rectal cancer surgery commonly results in ErD, EjD, and potency impairment. Robotic surgery provides lower EjD rates and less potency impairment. Comprehensive sexual function assessments are essential to inform patients and improve QOL outcomes.</p>\",\"PeriodicalId\":8017,\"journal\":{\"name\":\"Annals of surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2024-10-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SLA.0000000000006574\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006574","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
目的:调查男性性功能障碍(SD),包括勃起功能障碍(ErD)和射精功能障碍(EjD)的发生率:调查直肠癌微创手术后男性性功能障碍(SD)的发生率,包括勃起功能障碍(ErD)和射精功能障碍(EjD):背景:男性 SD 严重影响直肠癌术后的生活质量(QOL)。目前使用国际勃起功能指数-5(International Index of Erectile Function-5)进行的评估不适合术后性活动减少的患者,因为它假定患者有性交行为。本研究采用勃起硬度评分(EHS)和定制的射精问卷来弥补这一不足:这项前瞻性多中心开放标签 II 期试验招募了 399 名接受腹腔镜(Lap)、机器人(Ro)或经肛门(Ta)直肠癌手术的患者。EHS和定制的射精问卷评估了术后3、6和12个月的ErD、EjD和效力受损情况。在进行倾向性评分匹配后,在完整的分析集中对这些比率进行了评估,并在Lap组和Ro组之间进行了比较:结果:12 个月时,ErD 和 EjD 的总发生率分别为 34.7% 和 29.8%。Ro组的EjD发生率(25.0%)明显低于Lap组(40.9%),ErD发生率则无明显差异。在术后 6 个月(32.7% 对 22.3%)和 12 个月(29.0% 对 17.8%),Ro 组的药效受损率较低。Ta组在3个月时ErD和EjD相对较高,在12个月时有所恢复:结论:直肠癌微创手术通常会导致ErD、EjD和性功能损害。机器人手术的EjD发生率较低,对性功能的损害也较小。全面的性功能评估对告知患者和改善 QOL 结果至关重要。
Prospective Multicenter Comprehensive Survey on Male Sexual Dysfunction following Laparoscopic, Robotic, and Transanal Approaches for Rectal Cancer (the LANDMARC Study).
Objective: To investigate the incidence of male sexual dysfunction (SD) including erectile dysfunction (ErD) and ejaculatory dysfunction (EjD) after minimally invasive rectal cancer surgery.
Background: Male SD significantly affects post-rectal cancer surgery quality of life (QOL). Current assessments using the International Index of Erectile Function-5 are unsuitable for patients with reduced postoperative sexual activity, because it assumes sexual intercourse. This study addresses this gap using the Erection Hardness Score (EHS) and custom ejaculatory questionnaires.
Methods: This prospective multicenter open-label phase II trial enrolled 399 patients who underwent laparoscopic (Lap), robotic (Ro), or transanal (Ta) rectal cancer surgery. EHS and custom ejaculatory questionnaires assessed ErD, EjD, and potency impairment at 3, 6, and 12 months postoperatively. The rates were assessed in the full analysis set and compared between the Lap and Ro groups after propensity score matching.
Results: At 12 months, the overall incidences of ErD and EjD were 34.7% and 29.8%, respectively. The Ro group showed a significantly lower EjD rate (25.0%) than the Lap group (40.9%), with no significant difference in ErD. Potency impairment was lower in the Ro group at 6 months (32.7% vs. 22.3%) and 12 months (29.0% vs. 17.8%) postoperatively. The Ta group showed relatively high ErD and EjD at 3 months, with some recovery at 12 months.
Conclusions: Minimally invasive rectal cancer surgery commonly results in ErD, EjD, and potency impairment. Robotic surgery provides lower EjD rates and less potency impairment. Comprehensive sexual function assessments are essential to inform patients and improve QOL outcomes.
期刊介绍:
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.