Purpose

Anastomotic leakage after anterior resection for rectal cancer induces bowel dysfunction, but the influence on urinary and sexual function is largely unknown. This cross-sectional cohort study evaluated long-term effect of anastomotic leakage on urinary and sexual function in male patients.

Methods

Patients operated with anterior resection for rectal cancer in 15 Swedish hospitals 2007–2013 were identified. Anastomotic leakage and other clinical variables were retrieved from the Swedish Colorectal Cancer Registry and medical records. Urinary and sexual dysfunction were evaluated at 4 to 11 years after surgery using the International Prostate Symptom Score, International Index of Erectile Function, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire CR29. The effect of anastomotic leakage on average scores of urinary and sexual dysfunction was evaluated as a primary outcome, and the single items permanent urinary catheter and sexual inactivity as secondary outcomes. The association of anastomotic leakage and functional outcomes was analyzed using regression models with adjustment for confounders.

Results

After a median follow-up of 84 months (interquartile range: 67–110), 379 out of 864 eligible men were included. Fifty-nine (16%) patients had anastomotic leakage. Urinary incontinence was more common in the leakage group, with an adjusted mean score difference measured by EORTC QLQ ColoRectal–29 of 8.69 (95% confidence interval: 0.72–16.67). The higher risks of urinary frequency, permanent urinary catheter, and sexual inactivity did not reach significance.

Conclusion

Anastomotic leakage after anterior resection had a minor negative impact on urinary and sexual function in men.

中文翻译：

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直肠癌前切除术中吻合口瘘对男性长期泌尿和性功能的轻微影响

目的

直肠癌前切除术后吻合口漏会引起肠功能障碍，但对泌尿和性功能的影响尚不清楚。这项横断面队列研究评估了吻合口瘘对男性患者泌尿和性功能的长期影响。

方法

确定了 2007 年至 2013 年在 15 家瑞典医院接受直肠癌前切除术的患者。从瑞典结直肠癌登记处和医疗记录中检索吻合口漏和其他临床变量。术后 4 至 11 年使用国际前列腺症状评分、国际勃起功能指数和欧洲癌症研究与治疗组织生活质量问卷 CR29 评估排尿和性功能障碍。吻合口瘘对泌尿和性功能障碍平均评分的影响被评估为主要结局，单项永久性导尿管和性不活动作为次要结局。使用回归模型并调整混杂因素来分析吻合口瘘与功能结果的关联。

结果

经过中位随访 84 个月（四分位数范围：67-110）后，864 名符合条件的男性中有 379 名被纳入。五十九 (16%) 名患者出现吻合口瘘。尿失禁在漏尿组中更为常见，通过 EORTC QLQ ColoRectal–29 测量的调整后平均评分差异为 8.69（95% 置信区间：0.72–16.67）。尿频、永久性导尿管和性生活缺乏的较高风险并未达到显着性。

结论

前切除术后吻合口漏对男性的泌尿和性功能有轻微的负面影响。