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

Sep 23, 2026

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Aim: Evaluate how laparoscopic surgery affects sexual function in men with ultra-low rectal cancer located within 5 cm of the anal verge. Method: 139 male patients (≤70 years) with clinical T1-2N0M0 disease underwent laparoscopic surgery at 47 institutions (Jan 2014–Mar 2017). Sexual function was assessed with IIEF-15 and an ejaculation questionnaire preoperatively and at 3, 6, and 12 months. Results: IIEF-15 decreased significantly at 3 months with partial recovery by 12 months, yet remained below baseline. Age ≥56 predicted erectile dysfunction; ejaculatory recovery was incomplete, while orgasm, desire, and satisfaction neared baseline. Conclusion: Laparoscopic treatment significantly impacts male sexual function, especially in older patients.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

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DOI: 10. 1111/codi.70092 R E S E A RC H A RT I C L E 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 Ishiyama1 | Yasumitsu Hirano1 | Yuichiro Tsukada2 | Jun Watanabe3,4 | Yosuke Fukunaga5 | Kazuhiro Sakamoto6 | Hiroki Hamamoto7 | Masanori Yoshimitsu8 | Hisanaga Horie9 | Nobuhisa Matsuhashi10 | Yoshiaki Kuriu11 | Shuntaro Nagai12 | Madoka Hamada13 | Shinichi Yoshioka14 | Shinobu Ohnuma15 | Tamuro Hayama16 | Koki Otsuka17 | Yusuke Inoue18 | Kazuki Ueda19 | Yuji Toiyama20 | Satoshi Maruyama21 | Shigeki Yamaguchi22 | Keitaro Tanaka7,23 | Takeshi Naitoh24 | Masahiko Watanabe25 | Motoko Suzuki26 | Toshihiro Misumi26 | Masaaki Ito2 | Ultimate Trial Group in Japan Society of Laparoscopic Colorectal Surgery Correspondence Yasuhiro Ishiyama, Saitama Medical University International Medical Centre, 1397-1, Yamane, Hidaka-City, SaitamaPref, Japan. [Email:](Email: yishiyama1215@saitama-med.ac.jp)[ yishiyama1215@saitama-med.ac.jp](Email: yishiyama1215@saitama-med.ac.jp) 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. K E Y WO R D S ejaculatory dysfunction, rectal cancer, sexual function, ultra-low rectal cancer For affiliations refer to page 7. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s) . Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. 2 of 9 ISHIYAMA et al. INTRODUCTION Colorectal cancer is the fourth leading cause of cancer-related deaths in men, accounting for 9. 0% of all cancer-related deaths [1] . Rectal cancer accounts for approximately 25% of all colorectal cancer cases [2] . The incidence of rectal cancer is projected to increase further in the coming years [3] . Laparoscopic surgery for rectal cancer has demonstrated long-term efficacy [4], including through the use of robotic surgery [3, 4 , 5] and transanal total mesorectal excision (taTME) [6, 7] . Furthermore, the effectiveness of the watch-and-wait approach after chemoradiotherapy has been documented, indicating the ongoing evolution of rectal cancer treatment [8, 9] . However, in addition to oncological outcomes, the postoperative health-related quality of life must be maintained. Even with transanal tota

FAQs

What was the study aim regarding sexual function?

To evaluate postoperative sexual dysfunction after laparoscopic surgery for ultra-low rectal cancer located within 5 cm of the anal verge in male patients.

How were sexual function outcomes measured and when were they assessed?

Sexual function was assessed using the IIEF-15 and an ejaculation questionnaire before surgery and at 3, 6, and 12 months after surgery.

Which factor was identified as a risk factor for postoperative erectile dysfunction?

Age ≥56 years was identified as a significant risk factor for postoperative erectile dysfunction.

Sep 23, 2026

Uploaded by Ophelia