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Multicenter Study
. 2025 Apr;27(4):e70092.
doi: 10.1111/codi.70092.

Longitudinal follow-up of sexual function after surgery for ultra-low rectal cancers located within 5 cm of the anal verge: A multicentre collaborative study

Yasuhiro Ishiyama  1 , Yasumitsu Hirano  1 , Yuichiro Tsukada  2 , Jun Watanabe  3   4 , Yosuke Fukunaga  5 , Kazuhiro Sakamoto  6 , Hiroki Hamamoto  7 , Masanori Yoshimitsu  8 , Hisanaga Horie  9 , Nobuhisa Matsuhashi  10 , Yoshiaki Kuriu  11 , Shuntaro Nagai  12 , Madoka Hamada  13 , Shinichi Yoshioka  14 , Shinobu Ohnuma  15 , Tamuro Hayama  16 , Koki Otsuka  17 , Yusuke Inoue  18 , Kazuki Ueda  19 , Yuji Toiyama  20 , Satoshi Maruyama  21 , Shigeki Yamaguchi  22 , Keitaro Tanaka  7   23 , Takeshi Naitoh  24 , Masahiko Watanabe  25 , Motoko Suzuki  26 , Toshihiro Misumi  26 , Masaaki Ito  2 ; Ultimate Trial Group in Japan Society of Laparoscopic Colorectal Surgery
Affiliations
Multicenter Study

Longitudinal follow-up of sexual function after surgery for ultra-low rectal cancers located within 5 cm of the anal verge: A multicentre collaborative study

Yasuhiro Ishiyama et al. Colorectal Dis. 2025 Apr.

Abstract

Aim: The effect of laparoscopic surgery on sexual function in patients with ultra-low rectal cancer remains unexplored. This multicentre study evaluated postoperative sexual function in male patients with rectal cancer located within 5 cm of the anal verge.

Method: A total of 139 male patients aged ≤70 years with clinical T1-2N0M0 rectal cancer underwent laparoscopic surgery between January 2014 and March 2017 at 47 institutions. Sexual function was assessed using the International Index of Erectile Function (IIEF-15) and an ejaculation questionnaire preoperatively and at 3, 6, and 12 months postoperatively. Univariate and multivariate analyses were performed to examine risk factors for sexual dysfunction.

Results: The IIEF-15 scores showed a significant decrease at 3 months postoperatively, with partial recovery observed at 12 months; however, the scores remained below baseline levels. Age ≥ 56 years was identified as a significant risk factor for postoperative erectile dysfunction. Although ejaculatory function exhibited some improvement over 12 months, it did not return to preoperative levels. However, the orgasmic function, sexual desire, and overall satisfaction domains recovered close to their preoperative levels.

Conclusion: Laparoscopic surgery for ultra-low rectal cancer significantly affects male sexual function, particularly in older patients. These findings highlight the necessity for thorough preoperative counselling and targeted postoperative management to address sexual dysfunction.

Keywords: ejaculatory dysfunction; rectal cancer; sexual function; ultra‐low rectal cancer.

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Conflict of interest statement

The authors have no conflicts of interest directly relevant to the content of this article. The authors declare that no funding was received in support of this study.

Figures

FIGURE 1
FIGURE 1
Patient selection flow chart. APR, abdominoperineal resection; AV, anal verge; DL, dental line; ISR, intersphincteric resection; LAP, laparosocopic; LAR, low anterior resection.
FIGURE 2
FIGURE 2
Longitudinal changes in erectile function (IIEF‐15). EF, erectile function; IIEF‐5, International Index of Erectile Function‐5; IS, intercourse satisfaction; OF, orgasmic function; OS, overall satisfaction; SD, sexual desire.
FIGURE 3
FIGURE 3
Longitudinal analysis of temporal changes in ejaculatory function. M, month; Pre, preoperative; y, year.
See this image and copyright information in PMC

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