Erectile dysfunction (ErD) is an important complication after rectal cancer surgery, however a substantial proportion of patients experience functional recovery over time. Evidence regarding which patients are more likely to recover remains limited. This study aimed to identify factors associated with the recovery of postoperative ErD in male patients undergoing minimally invasive rectal cancer surgery.
This study was a sub-analysis of the LANDMARC study, a multicenter prospective trial across 49 hospitals, including male patients who underwent minimally invasive surgery for middle or lower rectal cancer. Erectile function was assessed preoperatively and up to 12 months postoperatively using the Erection Hardness Score (EHS). Analyses focused on ErD at 3 months and recovery at 12 months postoperatively. Modified Poisson regression was used to explore factors associated with recovery.
Among 337 patients with complete data, postoperative ErD was observed in 136 patients (40%). Of these, 67 patients (49%) showed recovery of ErD at 12 months. Factors associated with the recovery of ErD were upper tumor location (RR: 1.51; 95% CI: 1.06, 2.16), pathological T stage ≤ 2 (RR: 1.59; 95% CI: 1.07, 2.38), absence of neoadjuvant chemotherapy (RR: 2.05; 95% CI: 1.01, 4.13), and creation of a diverting stoma (RR: 1.85; 95% CI: 1.21, 2.85). Sensitivity analyses using alternative recovery definitions showed consistent results, particularly for tumor location and diverting stoma.
ErD after rectal cancer surgery is not always irreversible. These exploratory findings may help inform future studies aimed at developing individualized penile rehabilitation strategies after rectal cancer surgery.
Annals of gastroenterological surgery. 2026 Jul 03 [Epub ahead of print]
Ryosuke Mizuno, Koya Hida, Masakatsu Numata, Takashi Sakamoto, Kazutaka Obama, Akio Shiomi, Ryo Inada, Manabu Shiozawa, Mayumi Ozawa, Masanori Hotchi, Daisuke Yamamoto, Suguru Hasegawa, Masashi Miguchi, Shinobu Ohnuma, Tomohiro Yamaguchi, Tomonori Akagi, Yusuke Kinugasa, Shigeki Yamaguchi, Hiroyasu Kagawa, Masahiko Watanabe, Takeshi Naitoh, Ichiro Takemasa
Department of Surgery Kyoto University Hospital Kyoto Japan., Department of Surgery, Gastroenterological Center Yokohama City University Medical Center Yokohama Kanagawa Japan., Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan., Department of Gastroenterological Surgery Kochi Health Sciences Center Kochi Japan., Department of Gastroenterological Surgery Kanagawa Cancer Center Yokohama Kanagawa Japan., Department of Gastroenterological Surgery Yokohama City University Yokohama Kanagawa Japan., Department of Surgery Ehime Prefectural Central Hospital Matsuyama Ehime Japan., Department of Gastroenterological Surgery Ishikawa Prefectural Hospital Kanazawa Ishikawa Japan., Department of Gastroenterological Surgery Faculty of Medicine, Fukuoka University Fukuoka Japan., Department of Gastroenterological Surgery Hiroshima Prefectural Hospital Hiroshima Japan., Department of Surgery Tohoku University Graduate School of Medicine Sendai Miyagi Japan., Department of Colorectal Surgery Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan., Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Yufu Oita Japan., Department of Gastrointestinal Surgery Institute of Science Tokyo Tokyo Japan., Division of Colorectal Surgery, Department of Surgery Tokyo Women's Medical University Tokyo Japan., Department of Surgery Kitasato University Kitasato Institute Hospital Tokyo Japan., Department of Lower Gastrointestinal Surgery Kitasato University School of Medicine Sagamihara Kanagawa Japan., Department of Gastroenterological Surgery Osaka International Medical & Science Center Osaka Keisatsu Hospital Osaka Japan.