Published online Nov 27, 2016. doi: 10.4240/wjgs.v8.i11.744
Peer-review started: May 25, 2016
First decision: July 6, 2016
Revised: August 19, 2016
Accepted: September 7, 2016
Article in press: September 8, 2016
Published online: November 27, 2016
To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery.
A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors.
Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions.
There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.
Core tip: Urogenital dysfunction is a significant problem following rectal cancer surgery that significantly affects quality of life. Despite laparoscopic total mesorectal excision becoming the standard approach in much of the developed world, the incidence of post-operative urogenital dysfunction remains high. Robotic surgery allows for precision surgery in the pelvis, therefore enabling better preservation of the pelvic autonomic nerves. Current studies examining the urogenital outcomes following robotic rectal cancer surgery have several limitations, but suggest that robotic surgery may offer favourable outcomes when compared to laparoscopic and open surgery. Larger scale prospective studies are required to validate these results.