High Rate of Sexual Dysfunction Following Surgery for Rectal Cancer

Wafi Attaallah; Caglar Ertekin; Ilker Tinay; Cumhur Yegen

doi:10.3393/ac.2014.30.5.210

Articles

Page Path: HOME > Ann Coloproctol > Volume 30(5); 2014 > Article

Original Article High Rate of Sexual Dysfunction Following Surgery for Rectal Cancer: Wafi Attaallah, Caglar Ertekin, Ilker Tinay¹, Cumhur Yegen; Annals of Coloproctology 2014;30(5):210-215.
DOI: https://doi.org/10.3393/ac.2014.30.5.210
Published online: October 28, 2014

Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey.

¹Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.

Correspondence to: Wafi Attaallah, M.D. Department of General Surgery, Marmara University Pendik Teaching and Research Hospital, Fevzi Cakmak mah. Mimar Sinan cad. 41, Ustkaynarca, Pendik, Istanbul 34899, Turkey. Tel: +90 216 657 06 06, Fax: +90 216 657 06 95, drwafi2003@yahoo.com

• Received: January 19, 2014 • Accepted: April 28, 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next

5,742 Views
63 Download
33 Web of Science
35 Crossref
39 Scopus

Full Article

Download PDF

Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ARTICLE INFORMATION
REFERENCES

Abstract

Purpose
Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncological treatment, research on rectal-cancer survivors' sexual function remains limited. Sexual dysfunction (SD) after rectal cancer treatment was measured, and possible predisposing factors that may have an impact on the development of this disorder were identified.
Methods
Patients undergoing curative rectal cancer surgery from January 2012 to September 2013 were surveyed using questionnaires. The female sexual function index or the International Index of Erectile Function was recorded. A multiple logistic regression was used to test associations of clinical factors with outcomes.
Results
Fifty-six men (56%) and 28 women (44%) who completed the questionnaire were included in the study. A total of 76 patients of the 86 patients (90.5%) with the diagnosis of rectal cancer who were included in this study reported different levels of SD after radical surgery. A total of 64 patients (76%) from the whole cohort reported moderate to severe SD after treatment of rectal cancer. Gender (P = 0.011) was independently associated with SD. Female patients reported significantly higher rates of moderate to severe SD than male patients. Patients were rarely treated for dysfunction.
Conclusion
Sexual problems after surgery for rectal cancer are common, but patients are rarely treated for SD. Female patients reported higher rates of SD than males. These results point out the importance of sexual (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.
Keywords: Rectal neoplasms; Sexual dysfunction

INTRODUCTION

The main treatment goals for rectal cancer are oncological cure and overall survival. With improved oncological results, functional results such as fecal continence and urinary and sexual function become increasingly important [1]. Sexual dysfunction (SD) is a common complication of rectal cancer surgery [2]. Many patients experience deterioration in sexual function, consisting of erectile dysfunction (ED) in men and vaginal dryness and dyspareunia in women, after rectal cancer treatment [3]. Reduced sexual function is associated with lower quality of life in cancer survivors [4]. Although rectal cancer is a common malignancy and has an improved oncological cure rate, research on sexual function after rectal cancer surgery remains limited [5].

The aim of this study was to identify the frequency of SD after rectal cancer treatment. Also, possible predisposing factors that may have an impact on the development of SD are discussed.

METHODS

Study design & setting

The study was planned as a cross-sectional, single-arm cohort study. All cases of rectal cancer that involved surgery with curative intent at The Marmara University School of Medicine, Pendik Training & Research Hospital, from 2012 to 2013 were selected from a database of all colorectal cancer operations. The Research Ethics Committee of Marmara University approved the study, and all patients signed a written informed consent form before participation in the study.

Inclusion and exclusion criteria

Inclusion criteria were patients with rectal cancer who underwent a radical resection for any stage or rectal cancer. Survivors treated with surgery (with or without [neo]adjuvant therapy) were included. Exclusion criteria were an inability to obtain informed consent and transanal excision of the primary tumor.

Evaluation of the sexual function

Sexual function after treatment was measured using the validated questionnaire the female sexual function index for females and the International Index of Erectile Function (IIEF) for males. Validated self-reported psychometric questionnaires, such as IIEF and the Index of Female Sexual Function (IFSF), helped us to assess the impact of a specific treatment modality by evaluating different sexual function domains [6, 7]. The original IIEF, which consists of 15 items and 5 domains, is a psychometrically-valid and reliable instrument for ED assessment that was developed through consultations with an international panel of experts [6]. Each IIEF item is scored on a 5-point ordinal scale, where lower values represent poorer sexual function. Thus, a response of 1 for a question was considered the least functional whereas a response of 5 was considered the most functional. However, a need exists for a simpler patient-administered tool for the diagnosis of ED for easy use by physicians in clinical settings. An abbreviated version of the IIEF, designated as the IIEF-5, has been developed and validated as a diagnostic tool for ED [8]. According to the IIEF-5, ED can be classified into five severity levels, ranging from none (22-25), to mild (17-21), mild-to-moderate (12-16), moderate (8-11), and severe (5-7).

The IFSF, a 9-item questionnaire, has been developed as a brief, multidimensional self-reporting instrument for assessing the key dimensions of sexual function in women [7]. Specific domains analyzed in the IFSF included quality of sexual intercourse, desire, overall satisfaction with sexual function, orgasm, lubrication, and clitoral sensation. Specific questions analyzed included the degree of lubrication, the ability to achieve orgasm, and the degree of clitoral sensation, with responses graded on a scale of 1 (almost never or never) to 5 (almost always or always) [7]. A score of 0 indicated no attempt at intercourse. According to the IFSF, SD in women can be classified into four levels, ranging from none (≥35) to mild (26-35), moderate (16-25) and severe (≤15) in the Turkish female population [9]. For the assessment of the possible predisposing factors that may have an impact on the development of SD, we separated the patients into two groups (A and B) according to their SD scores: namely, no and mild SD in one group (group A) and mild-to-moderate, moderate and severe in the other group (group B).

Clinical data

Information on age, gender, histological diagnosis, surgical procedure, pathological TNM stage, (neo)adjuvant treatment, and postoperative complications such as anastomosis leakage, bleeding, complications of ostomy, evisceration, perineal complications, reoperations were obtained from the medical records. These data were obtained for all patients who underwent surgery for rectal cancer between 2012 and 2013 at one center.

Statistical analysis

Background clinical data were analyzed using the t-test for continuous data and Fisher exact test or the chi-square test for categorical data. Data for the total IIEF and IFSF scores and their domain scores were analyzed using a two-way analysis of variance. A multivariate logistic regression analysis with 95% confidence interval was used to identify factors associated with SD. Data were analyzed using SPSS ver. 17.0 (SPSS Inc., Chicago, IL, USA). All tests were two-sided, and P-values below 0.05 were considered statistically significant.

RESULTS

Patient characteristics

Between January 2012 and September 2013, 157 patients were operated on for rectal cancer in the General Surgery Clinic at Marmara University School of Medicine, Pendik Training & Research Hospital. A transanal excision was done for 2 patients, and a radical resection was performed for 155 patients (abdominoperineal resection for 37 patients, and low anterior resection for 120 patients). Patients who underwent a transanal excision were excluded. We had access to 125 patients who underwent a radical resection with abdominal surgery. Of the 125 patients, 114 were alive, and 11 had died. Thirty patients did not accept participating in the study. Five of those 30 patients did not accept participating in the study because they were not able to come to the hospital. The other 25 patients were not sexually active and, accordingly, did not accept the study. The remaining 84 patients who accepted the study and signed the informed consent forms were invited to the hospital so that evaluate their sexual functions could be evaluation (Fig. 1). All patients' median age was 60 years (28-91 years), and all of them were diagnosed with an adenocarcinoma. The demographic and the clinical characteristics of the patients are shown in Table 1.

In this study, 56 patients (67%) were male. The operative methods were abdominoperineal resection with open surgery in 23 patients (27.4%), low anterior resection without ostomy in 33 (39.3%; open surgery, n = 31; laparoscopic surgery, n = 2), low anterior resection with protective ostomy in 12 (14.3%; open surgery, n = 11; laparoscopic surgery, n = 1), and Hartmann's procedure in 16 patients (19%). The median distance between the anal verge and the tumor was 9 cm (range, 1-15 cm).

More than half of the patients had T3 as a primary tumor stage (51.2%, n = 43). Regional lymph nodes stage was N0 in 51 patients (60.7%). Distant metastasis was observed in 5 patients (6%). Nineteen patients (23%) underwent preoperative chemoradiotherapy. A total of 54 patients (64%) underwent postoperative chemotherapy, including 44 (52%) who received concomitant adjuvant radiotherapy. The median time between neoadjuvant radiotherapy and surgery was 57 days (range, 35-270 days). The median follow-up period for the entire cohort was 9.8 months (range, 1-20 months). Of the 28 patients who had a nonpermanent stoma, 5 patients (18%) underwent a stoma reversal. A total of 54 patients (64%) had a follow-up period of more than 6 months. Anastomotic leakage was diagnosed in 10 patients (23%) who underwent a low anterior resection with anastomosis, but it was necessary to reoperate on and create a diverting ostomy in only 4 patients (9%). The other 6 patients were healed by using antibiotics and observation.

Sexual function

Using the validated IIEF-5 and IFSF questionnaires, 76 patients (90.5%) reported different levels of SD after radical surgery. A total of 64 patients (76%) from the whole cohort reported moderate-to-severe SD after treatment of rectal cancer. Among the male patients, 6 (10.7%) reported no SD, 12 (21.4%) reported mild, 26 (46.4%) reported mild-to-moderate, 7 (12.5%) reported moderate, and 5 (9.0%) reported severe SD. Among the female patients, 1 (3.7%) reported no SD, 1 (3.7%) reported mild, 19 (70.4%) reported moderate, and 6 (22.2%) reported severe SD. Female patients reported significantly higher rates of moderate-to-severe SD than male patients (93% vs. 68%, respectively; P = 0.011). In the univariate analysis, the postoperative adjuvant chemotherapy rate was significantly higher in group B than in group A (70% vs. 45%, respectively; P = 0.039). The vascular invasion rate in the final pathology report was also significantly higher in group A than in group B, (33% vs. 5%, respectively; P = 0.014). In the multivariate logistic regression analysis, the difference in gender between groups A and B was significant (P = 0.018), but the differences in adjuvant chemotherapy and vascular invasion rate were not significant (P = 0.40 and P = 0.051, respectively). Although a high rate of SD was reported by the patients in this study (90.5%), only 6 patients (8%) sought and received treatment for SD.

DISCUSSION

This study, which included 84 patients with rectal cancer, showed that SD is a common complaint in patients with rectal cancer after radical treatment. The rate of SD was high (90.5%) in this study cohort. Female patients had a significantly higher rate (93%) of SD than male patients (67%) did.

Conventionally, outcome assessments in colorectal cancer include mortality, morbidity, disease recurrence, and long-term survival. However, patient-reported outcomes (e.g., quality of life) are now also regarded as key measurements in assessing outcomes of interventions [10]. Sexuality and intimacy are considered to be important aspects of quality of life [11]. While rectal cancer treatment has clearly produced improved outcomes for the disease, patients are still plagued by the complications and the long-term consequences of their treatment. SD after rectal cancer treatment is common and can have major negative effects on the quality of life. Despite this, it is not often discussed in clinical practice. Patients are unlikely to mention these problems themselves either because they are embarrassed or because they do not relate their symptoms to their rectal cancer treatment [3]. These complications can have a major impact on patients' psychological, social, and emotional functioning, as well as on their overall well-being [12]. This study fills this gap and highlights the less discussed issue of SD [4]; it also supports the need for studies related to SD after rectal cancer treatment.

This study has some limitations that need to be acknowledged. First, this was a cross-sectional study, and no information was known about sexual (dys)function before diagnosis/treatment of cancer, which limited the determination of the effect of cancer diagnosis and treatment on functioning or on the ability to correct for baseline functioning. Prospective studies with an assessment point prior to surgical treatment are warranted. Second, our study has a potential sampling bias. The study population is a "convenience cohort" of surviving rectal cancer patients who were treated in one center. Therefore, results may not be generalizable to all patients undergoing rectal cancer surgery. Procedure subgroups were not randomly assigned and differed in their tumor characteristics as well as their treatments. The final limitation is the small number of patients for evaluating the factors associated with SD after rectal cancer treatment.

SD is a well-recognized complication after total mesorectal excision (TME) and has a negative impact on patients' quality of life. The incidence of SD after TME is reported to be 18%-54% [12, 13, 14], depending on the type of surgery, neoadjuvant treatment especially radiotherapy, and/or quality of dissection [15]. There are several reasons the rate of SD reported in this study appears high (90.5%) compared with other recent studies. First, this study did not exclude patients based on age or preexisting sexual inactivity or dysfunction, exclusions that bias results toward better function. Second, the median follow-up period (9.8 months) may be too short to evaluate patients after treatment for rectal cancer. Nevertheless, rates of long-term ED ranging from 59% to 90% have been reported in other studies [16, 17, 18]. Widely varying rates of SD after rectal surgery have been reported in the literature, and comparisons between studies are difficult due to the different exclusion criteria and outcome measures used in those studies [19, 20].

Unexpectedly, female patients reported significantly higher rates of SD than male patients (93% vs. 67%, respectively; P = 0.011). While a number of studies have examined rates of SD after surgery for rectal cancer, the primary focus has been on the male sexual issue of ED. Research on female rectal cancer survivors' sexual function remains limited, and generally it is ignored during surgery [19, 21, 22]. Moreover, female SD after surgery for rectal cancer has been relatively ignored [13] due in part to the reluctance of women with rectal cancer to respond to questions about their sexuality [16]. Two factors may help explain the relatively higher rates of SD in female than in male patients: (1) nerve preservation is relatively ignored during surgery in females, and (2) early menopause resulting from (neo)adjuvant chemoradiotherapy may lead to SD after treatment. Moreover, women are more likely than men to give up sexual activity after colorectal cancer treatment [16]. Although adjuvant chemotherapy does not increase the risk of male SD [23], adjuvant pelvic radiotherapy or chemoradiation does increase the rate of ED [14]. Rather unexpected was the finding that radiotherapy was not significantly associated with SD. Considering that radiotherapy is one of the most robust findings in the literature, our contradictory finding is noteworthy. The inconsistency with the literature may be explained by the small number of our cohort and by the inclusion of patients with different stages of rectal cancer.

Stoma status and type of resection were not significantly different between the groups with and without SD. Milbury et al. [5] reported that neither having a stoma nor type of resection was significantly related to SD for women. This study showed that most patients did not get treatment for SD. Although one randomized trial showed that sildenafil (Viagra) was effective in 79% of male patients with ED after rectal excision for cancer, the effect of these drugs depends on intact pelvic splanchnic nerves [24]. Therefore, nerve preservation during rectal cancer surgery needs to be given greater emphasis in surgical practice. SD can be influenced postoperatively by factors other than surgery alone, such as the recovery period after surgery, coping with disease, and body image. These factors are temporary and do not influence the results after a long-term follow-up. In the case of partial nerve damage, initial dysfunction can be temporarily reduced, but recovery is possible in the first years after the initial operation. However, ED in male rectal-resection patients persists in time [25]. Prospective studies indicate that other indices of quality of life typically improve over time, yet sexual function remains impaired [26, 27].

In conclusion, this study showed that rectal cancer survivors had a high rate of SD, which was seldom treated. Female patients reported higher rates of SD than male patients. These results imply that attention needs to be drawn to SD among male and female survivors of rectal cancer in both research and clinical practice.

ARTICLE INFORMATION

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Bloom JR, Petersen DM, Kang SH. Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psychooncology 2007;16:691–706. Article PubMed
2. Desnoo L, Faithfull S. A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery. Eur J Cancer Care (Engl) 2006;15:244–251. Article PubMed
3. Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol 2011;8:51–57. Article PubMed
4. Vironen JH, Kairaluoma M, Aalto AM, Kellokumpu IH. Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum 2006;49:568–578. Article PubMed
5. Milbury K, Cohen L, Jenkins R, Skibber JM, Schover LR. The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer 2013;21:793–802. Article PubMed
6. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–830. Article PubMed
7. Kaplan SA, Reis RB, Kohn IJ, Ikeguchi EF, Laor E, Te AE, et al. Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction. Urology 1999;53:481–486. Article PubMed
8. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;11:319–326. Article PubMed
9. Guvel S, Yaycioglu O, Bagis T, Savas N, Bulgan E, Ozkardes H. Factors associated with sexual function in married women. Turkish J Urol 2003;29:43–48.
10. Sprangers MA. Quality-of-life assessment in oncology: achievements and challenges. Acta Oncol 2002;41:229–237. Article PubMed
11. Hassan I, Cima RR. Quality of life after rectal resection and multimodality therapy. J Surg Oncol 2007;96:684–692. Article PubMed
12. Nesbakken A, Nygaard K, Bull-Njaa T, Carlsen E, Eri LM. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg 2000;87:206–210. Article PubMed
13. Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 1996;182:495–502. PubMed
14. Marijnen CA, van de Velde CJ, Putter H, van den Brink M, Maas CP, Martijn H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2005;23:1847–1858. Article PubMed
15. Eveno C, Lamblin A, Mariette C, Pocard M. Sexual and urinary dysfunction after proctectomy for rectal cancer. J Visc Surg 2010;147:e21–e30. Article
16. Hendren SK, O'Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005;242:212–223. Article PubMed PMC
17. Maurer CA, Z'Graggen K, Renzulli P, Schilling MK, Netzer P, Buchler MW. Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery. Br J Surg 2001;88:1501–1505. Article PubMed
18. Ameda K, Kakizaki H, Koyanagi T, Hirakawa K, Kusumi T, Hosokawa M. The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer. Int J Urol 2005;12:256–263. Article PubMed
19. Havenga K, Maas CP, DeRuiter MC, Welvaart K, Trimbos JB. Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer. Semin Surg Oncol 2000;18:235–243. Article PubMed
20. Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 2000;87:1288–1299. Article PubMed
21. Hida K, Hasegawa S, Kataoka Y, Nagayama S, Yoshimura K, Nomura A, et al. Male sexual function after laparoscopic total mesorectal excision. Colorectal Dis 2013;15:244–251. Article PubMed
22. Masui H, Ike H, Yamaguchi S, Oki S, Shimada H. Male sexual function after autonomic nerve-preserving operation for rectal cancer. Dis Colon Rectum 1996;39:1140–1145. Article PubMed
23. Heriot AG, Tekkis PP, Fazio VW, Neary P, Lavery IC. Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model. Ann Surg 2005;242:502–510. Article PubMed PMC
24. Lindsey I, George B, Kettlewell M, Mortensen N. Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Dis Colon Rectum 2002;45:727–732. Article PubMed
25. Doeksen A, Gooszen JA, van Duijvendijk P, Tanis PJ, Bakx R, Slors JF, et al. Sexual and urinary functioning after rectal surgery: a prospective comparative study with a median follow-up of 8.5 years. Int J Colorectal Dis 2011;26:1549–1557. Article PubMed PMC
26. Camilleri-Brennan J, Steele RJ. Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. Br J Surg 2001;88:1617–1622. Article PubMed
27. Allal AS, Gervaz P, Gertsch P, Bernier J, Roth AD, Morel P, et al. Assessment of quality of life in patients with rectal cancer treated by preoperative radiotherapy: a longitudinal prospective study. Int J Radiat Oncol Biol Phys 2005;61:1129–1135. Article PubMed

Fig. 1

Flowchart for inclusion in the study.

Table 1

Characteristics of patients according to the outcome of study treatment

Values are presented as median (range) or number (%).

SD, sexual dysfunction.

^aComparison between groups A and B. ^bt-test for independent samples. ^cChi-square test. ^dFisher exact test.

Figure & Data

References

Citations

Citations to this article as recorded by

The decline of male sexual activity and function after surgical treatment for rectal cancer
Anne Thyø, Peter Christensen, Ismail Gögenur, Marianne Krogsgaard, Michael B. Lauritzen , Birgitte S. Laursen, Anette H. Mikkelsen , Asbjørn M. Drewes, Therese Juul
Acta Oncologica.2025; 64: 47. CrossRef
High prevalence of erectile dysfunction within the first year after surgery for rectal cancer: A systematic review and meta-analysis
Sebastian B. Hansen, Siv Fonnes, Birthe Thing Oggesen, Jacob Rosenberg
European Journal of Surgical Oncology.2024; 50(12): 108662. CrossRef
IL-17A exacerbates corpus cavernosum fibrosis and neurogenic erectile dysfunction by inducing CSMC senescence via the mTORC2-ACACA pathway
Wende Yang, Jiafeng Fang, Jiancheng Zhai, Chen Qiu, Zhenkang Liang, Qianhui Liu, Hongbo Wei
BMC Medicine.2024;[Epub] CrossRef
Restoring sexual function in women with early-stage cervical cancer
D. Blinov, A. Solopova, E. Gameeva, N. Badalov, A. Stepanova, M. Eremushkin, S. Akavova, A. Ivanov, V. Galkin
Vrach.2024; : 5. CrossRef
Diffuse reflection spectroscopy at the fingertip: design and performance of a compact side-firing probe for tissue discrimination during colorectal cancer surgery
Freija Geldof, Mark Witteveen, Henricus J. C. M. Sterenborg, Theo J. M. Ruers, Behdad Dashtbozorg
Biomedical Optics Express.2023; 14(1): 128. CrossRef
Patient-Reported Outcomes in Colorectal Surgery
Marianna Maspero, Tracy Hull
Clinics in Colon and Rectal Surgery.2023; 36(04): 240. CrossRef
Controversies and management of deficient mismatch repair gastrointestinal cancers in the neoadjuvant setting
Mélina Boutin, Sharlene Gill
Therapeutic Advances in Medical Oncology.2023;[Epub] CrossRef
Evaluation of Depression, Anxiety, and Sexual Function in Rectal Cancer Patients Before and After Neoadjuvant Chemoradiotherapy
Meltem Dağdelen, Tuba Kurt Çatal, Ömer Faruk Demirel, Esra Ürün, Selma Kaçar, Kimia Çepni, Günay Can, Didem Çolpan Öksüz, Alaatin Duran
Journal of Gastrointestinal Cancer.2023; 54(4): 1347. CrossRef
The erectile and ejaculatory implications of the surgical management of rectal cancer
Armin Ghomeshi, John Zizzo, Raghuram Reddy, Joshua White, Aden Swayze, Sanjaya Swain, Ranjith Ramasamy
International Journal of Urology.2023; 30(10): 827. CrossRef
Functional Results After Nerve-Sparing, Sphincter Preserving Rectal Cancer Surgery: Patient-Reported Outcomes of Sexual and Urinary Dysfunction
Swapnil Patel, Sriniket Raghavan, Vidur Garg, Mufaddal Kazi, Vivek Sukumar, Ashwin Desouza, Avanish Saklani
Indian Journal of Surgical Oncology.2023; 14(4): 868. CrossRef
Erectile Dysfunction Is Common after Rectal Cancer Surgery: A Cohort Study
Sebastian Borgund Hansen, Birthe Thing Oggesen, Siv Fonnes, Jacob Rosenberg
Current Oncology.2023; 30(10): 9317. CrossRef
Endoscopic and trans-anal local excision vs. radical resection in the treatment of early rectal cancer: A systematic review and network meta-analysis
Charlotte Kwik, Toufic El-Khoury, Nimalan Pathma-Nathan, James Wei Tatt Toh
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Distinctive features of small vessels on the mesorectal and parietal pelvic fascia as important landmarks in guiding precise inter-fascial dissection for low rectal cancer
Qingbin Wu, Mingtian Wei, Xubing Zhang, Xiangbing Deng, Ziqiang Wang
Surgical Endoscopy.2022; 36(2): 1657. CrossRef
Erectile dysfunction resulting from pelvic surgery is associated with changes in cavernosal gene expression indicative of cavernous nerve injury
Guillermo Villegas, Moses Tarndie Tar, Kelvin Paul Davies
Andrologia.2022;[Epub] CrossRef
Identification of Risk Factors for Sexual Dysfunction after Multimodal Therapy of Locally Advanced Rectal Cancer and Their Impact on Quality of Life: A Single-Center Trial
Peter Tschann, Markus Weigl, Thomas Brock, Jürgen Frick, Oliver Sturm, Jaroslav Presl, Tarkan Jäger, Michael Weitzendorfer, Philipp Schredl, Patrick Clemens, Helmut Eiter, Philipp Szeverinski, Christian Attenberger, Veronika Tschann, Walter Brunner, Alexa
Cancers.2022; 14(23): 5796. CrossRef
Male erectile function after treatment for colorectal cancer: a population‐based cross‐sectional study
Jens Reumert Laurberg, Viktoria Reumert Laurberg, Hossam Elfeki, Jørgen Bjerggaard Jensen, Katrine J. Emmertsen
Colorectal Disease.2021; 23(2): 367. CrossRef
Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis
Athina A. Samara, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Symeonidis, Alexandros Diamantis, Konstantinos Tepetes
International Journal of Colorectal Disease.2021; 36(7): 1385. CrossRef
Prospective study of sexual function and analysis of risk factors after rectal cancer surgery
Inmaculada Torrijo, Zutoia Balciscueta, Janine Tabet, M. Carmen Martín, Manuel López, Natalia Uribe
Colorectal Disease.2021; 23(6): 1379. CrossRef
Risk factors for sexual dysfunction after rectal cancer surgery in 948 consecutive patients: A prospective cohort study
Kai Li, Xiaobo He, Shilun Tong, Yongbin Zheng
European Journal of Surgical Oncology.2021; 47(8): 2087. CrossRef
Prevalence of erectile dysfunction in male survivors of cancer: a systematic review and meta-analysis of cross-sectional studies
Damiano Pizzol, Tao Xiao, Lee Smith, Guillermo F López Sánchez, Andrea Garolla, Christopher Parris, Yvonne Barnett, Petre Cristian Ilie, Pinar Soysal, Jae Il Shin, Mark A Tully, Lin Yang, Nicola Veronese, Igor Grabovac
British Journal of General Practice.2021; 71(706): e372. CrossRef
Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach
Jacopo Crippa, Fabian Grass, Eric J. Dozois, Kellie L. Mathis, Amit Merchea, Dorin T. Colibaseanu, Scott R. Kelley, David W. Larson
Annals of Surgery.2021; 274(6): e1218. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Ressecção anterior do reto vs prostatectomia radical. Existem diferenças na reabilitação sexual?
Nuno Ramos, Rodrigo Ramos, Eduardo Silva
Revista do Colégio Brasileiro de Cirurgiões.2020;[Epub] CrossRef
Long term sexual function following rectal cancer treatment
Joyce H. Pang, Zoë Jones, Orrin B. Myers, Sarah Popek
The American Journal of Surgery.2020; 220(5): 1258. CrossRef
Placement of Inflatable Penile Implants in Patients With Prior Radical Pelvic Surgery: A Literature Review
SriGita K. Madiraju, Tariq S. Hakky, Paul E. Perito, Jared J. Wallen
Sexual Medicine Reviews.2019; 7(1): 189. CrossRef
Changes in Sexual Function of Patients with Cancer in Turkey
Ayse Cil Akinci, Fatma Cosar Cetin, Rujnan Tuna, Neriman Zengin, Mahmut Gumus
Sexuality and Disability.2019; 37(3): 441. CrossRef
Prospective study of sexual dysfunction after proctectomy for rectal cancer
Wafi Attaallah, Suleyman Caglar Ertekin, Cumhur Yegen
Asian Journal of Surgery.2018; 41(5): 454. CrossRef
Evaluation of Sexual Satisfaction and Function in Patients Following Stoma Surgery: A Descriptive Study
Emel Sutsunbuloglu, Fatma Vural
Sexuality and Disability.2018; 36(4): 349. CrossRef
Survey on consenting practice and discussion of post-operative erectile dysfunction following rectal cancer surgery
Yih Chyn Phan, Joseph Sebastian, Mohan Harilingam, George Tsavellas
Journal of Clinical Urology.2017; 10(1): 62. CrossRef
Sexual dysfunction following rectal cancer surgery
V Celentano, R Cohen, J Warusavitarne, O Faiz, M Chand
International Journal of Colorectal Disease.2017; 32(11): 1523. CrossRef
Phosphodiesterase-5 Inhibitors and Vacuum Erection Device for Penile Rehabilitation After Laparoscopic Nerve-Preserving Radical Proctectomy for Rectal Cancer: A Prospective Controlled Trial
Haijun Deng, Dong Liu, Xiangming Mao, Xiaoliang Lan, Hao Liu, Guoxin Li
American Journal of Men's Health.2017; 11(3): 641. CrossRef
Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring—a Prospective 2-Year Follow-Up Study
Daniel W. Kauff, Hauke Lang, Werner Kneist
Journal of Gastrointestinal Surgery.2017; 21(6): 1038. CrossRef
The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A)
Roy J. Levin, Stephanie Both, Janniko Georgiadis, Tuuli Kukkonen, Kwangsung Park, Claire C. Yang
The Journal of Sexual Medicine.2016; 13(5): 733. CrossRef
Quality of life after surgery for rectal cancer: a systematic review of comparisons with the general population
Francesca Giandomenico, Teresa Gavaruzzi, Lorella Lotto, Paola Del Bianco, Andrea Barina, Alessandro Perin, Salvatore Pucciarelli
Expert Review of Gastroenterology & Hepatology.2015; 9(9): 1227. CrossRef
Sexual Function After a Proctectomy for the Treatment of Rectal Cancer
Young Wan Kim, Ik Yong Kim
Annals of Coloproctology.2014; 30(5): 205. CrossRef

Cite this Article

Cite this Article: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format: