腹腔镜、机器人和经肛门直肠癌治疗后男性性功能障碍的前瞻性多中心综合调查（LANDMARC 研究）。
Prospective Multicenter Comprehensive Survey on Male Sexual Dysfunction following Laparoscopic, Robotic, and Transanal Approaches for Rectal Cancer (the LANDMARC Study).
发表日期：2024 Oct 22
作者：
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,
来源：
ANNALS OF SURGERY
摘要：
探讨直肠癌微创术后男性性功能障碍（SD）包括勃起功能障碍（ErD）和射精功能障碍（EjD）的发生率。男性SD显着影响直肠癌术后生活质量（QOL）。目前使用国际勃起功能指数 5 的评估不适合术后性活动减少的患者，因为它假设性交。本研究使用勃起硬度评分 (EHS) 和定制射精问卷来解决这一差距。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 和定制射精问卷评估了术后 3、6 和 12 个月的 ErD、EjD 和性功能障碍。在完整的分析集中评估发生率，并在倾向评分匹配后在 Lap 组和 Ro 组之间进行比较。12 个月时，ErD 和 EjD 的总体发生率分别为 34.7% 和 29.8%。 Ro组的EjD率（25.0%）显着低于Lap组（40.9%），而ErD没有显着差异。 Ro 组术后 6 个月（32.7% vs. 22.3%）和 12 个月（29.0% vs. 17.8%）时的效能损害较低。 Ta组在3个月时表现出相对较高的ErD和EjD，并在12个月时有所恢复。微创直肠癌手术通常会导致ErD、EjD和效能损害。机器人手术可降低 EjD 发生率并减少效能损害。全面的性功能评估对于告知患者和改善生活质量结果至关重要。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。
To investigate the incidence of male sexual dysfunction (SD) including erectile dysfunction (ErD) and ejaculatory dysfunction (EjD) after minimally invasive rectal cancer surgery.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.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.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.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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.