Impact on defecatory, urinary and sexual function after high-tie sigmoidectomy: a post-hoc analysis of a multicenter randomized controlled trial comparing extended versus standard complete mesocolon excision.

Autor: Planellas P; Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, 17007, Girona, Spain. planellasp@gmail.com.; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain. planellasp@gmail.com.; Girona Biomedical Research Institute (IDIBGI), Girona, Spain. planellasp@gmail.com., Marinello F; Colorectal Surgery Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain., Elorza G; Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Donostia, Donostia, Spain., Golda T; Colorectal Surgery Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain., Farrés R; Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, 17007, Girona, Spain.; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.; Girona Biomedical Research Institute (IDIBGI), Girona, Spain., Espín-Basany E; Colorectal Surgery Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain., Enríquez-Navascués JM; Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Donostia, Donostia, Spain., Kreisler E; Colorectal Surgery Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain., Cornejo L; Girona Biomedical Research Institute (IDIBGI), Girona, Spain., Codina-Cazador A; Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, 17007, Girona, Spain.; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.; Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2023 Aug 01; Vol. 408 (1), pp. 293. Date of Electronic Publication: 2023 Aug 01.
DOI: 10.1007/s00423-023-03026-9
Abstrakt: Objective: To assess the effect of high inferior mesenteric artery tie on defecatory, urinary, and sexual function after surgery for sigmoid colon cancer. Performing a sigmoidectomy poses a notable risk of causing injury to the preaortic sympathetic nerves during the high ligation of the inferior mesenteric artery, as well as to the superior hypogastric plexus during dissection at the level of the sacral promontory. Postoperative defecatory and genitourinary dysfunction after sigmoid colon resection are often underestimated and underreported.
Methods: This study is a secondary research of a multicenter, single-blind, randomized clinical trial. The trial involved patients with sigmoid cancer who underwent either extended complete mesocolic excision (e-CME) or standard CME (s-CME). Patients completed questionnaires to assess defecatory, urinary, and sexual function before, 1 month after surgery, and 1 year after surgery. Multivariate analysis was conducted to identify factors associated with functional dysfunction.
Results: Seventy-nine patients completed functional assessments before and 1 year after surgery. One year after sigmoidectomy with a high tie of the inferior mesenteric artery, 15.2% of patients had minor low anterior resection syndrome (LARS) and 12.7% had major LARS; 22.2% of males and 29.4% of females had urinary dysfunction; and 43.8% of males and 27.3% of females had sexual dysfunction. After multivariate analysis, no significant associations were found between clinical and surgical factors and gastrointestinal or urinary dysfunction after 1 year of surgery. Age was identified as the only factor linked to sexual dysfunction in both sexes (women, β =  - 0.54, p = 0.002; men β =  - 0.38, p = 0.010). Regarding recovery outcomes, diabetes mellitus was identified as a contributing factor to suboptimal gastrointestinal recovery (p = 0.033) and urinary recovery in women (p = 0.039). Furthermore, the treatment arm was found to be significantly associated with the recovery of erectile function after 1 year of surgery (p = 0.046).
Conclusions: A high tie of the inferior mesenteric artery during sigmoidectomy is associated with a high incidence of defecatory and genitourinary dysfunction. Age was identified as a significant factor associated with sexual dysfunction 1 year after sigmoid colon resection in both sexes.
Trial Registration: Clinical trials NCT03083951 HIGHLIGHTS: • One year after high-tie sigmoidectomy, 27.9% of patients had LARS; 22.2% of the men and 29.4% of the women had urinary dysfunction; and 43.8% of the men and 27.3% of the women had sexual dysfunction. • e-CME is associated with a high rate of urinary dysfunction in men 1 year after surgery. However, after multivariate analysis, no association was found between e-CME and urinary dysfunction in men. • Age was correlated with the recovery of sexual function in both sexes 1 year after surgery. Furthermore, diabetes mellitus was identified as the factor associated with poorer recovery of urinary function in females.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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