1 12 13 17 18 20 PATIENTS AND METHODS 10 21 22 Surgical Strategy 1 1 1 1 Fig. 1 A B C D  23 1 1 Assessment of Urinary Function 10 Assessment of Sexual Function Sexual function was evaluated preoperatively and 6 months after operation or recovery from surgical complications, if present. 21 22 Data Management Data on patients undergoing laparoscopic autonomic nerve-preserving surgery for sigmoid colon cancer between January 2004 and December 2006 were entered into a prospective database of the present study. Until June 2007, the mean time of follow-up for the patients was 18 months, ranging from 6 to 36 months. The genitourinary function of the patients was analyzed by the intention-to-treat principle. Patients were first contacted by telephone by a research assistant who described the nature of the project. Those who consented to the present study were given a questionnaire-based interview by the research assistant. The data were managed by a statistician. To prevent bias of evaluation, the research assistant was not told which surgical procedure was performed for each individual patient. P t P RESULTS 1 Table 1 Demographics, clinicopathologic data, and surgical outcomes of patients undergoing laparoscopic autonomic nerve-preserving surgery for sigmoid colon cancer (n = 112) Parameter a Age (years) 55.8 ± 6.4 Sex (M/F) 58/54 2 2     Male 23.4 (20.3∼31.6)     Female 24.8 (22.0∼32.5) ASA class     I 62     II 46     III 4 TME stage (pathologic)      I 8     II 54     III 50 Operative time (minutes) 184.4 ± 44.8 Conversion rate  .9% (n = 1) Blood loss (mL) 84.5 ± 24.0 Postoperative ileus (hours) 48.0 ± 8.4 Hospitalization (days) 8.0 ± 2.0 Postoperative pain (visual analog scale) 3.5 ± .4 Postoperative complication     Total 7.1% (n = 8)     Wound infection 4     Deep vein thrombosis 1     Pneumonia  1     Anastomotic leakage 2 No. of lymph nodes collected 14.4 ± 4.0 Tumor recurrence rate 8.0% (n = 9) ASA, American Society of Anesthesiology; TNM, tumor, node, metastasis system. a 2 P t 3 P t 3 P t Table 2 Changes in urinary function before and after surgery for patients with successful nerve-preserving surgery (n = 104) Urinary function (range of IPSS) Before operation After operation P a     Good (0–7) 104 98      Fair (8–14) 0 5      Poor (15–35) 0 1  IPSS score (mean ± SD) 3.20 ± 1.72 3.68 ± 2.82 .075 IPSS, International Prostate Symptom Score. a P t Table 3 Changes in sexual function for male and female patients with successful nerve-preserving surgery Function Before Operation After Operation P a Male patients (n = 44) Ejaculatory function     Good 44 40      Fair 0 3      Poor 0 1  Erectile function (IIEF Score)      Good (60–75) 44 41      Fair (44–59) 0 2      Poor (5–43) 0 1  IIEF score (mean ± SD) 72.4 ± 4.6 70.3 ± 8.4 .082 Female patients (n = 42)  Sexual function (FSFI Score)      Good (76–95) 42 36      Fair (58–75) 0 4      Poor (4–57) 0 2  FSFI score (mean ± SD) 89.0 ± 9.2 85.4 ± 16.4 .122 IIEF, International Index of Erectile Function; FSFI, Female Sexual Function Index. a P t 4 Table 4 Changes of values in specific domains of the scoring system for evaluation of genitourinary function in patients who failed the procedures of nerve-preserving surgery (n = 4) Domain Patient 1 (male) Patient 2 (female) Patient 3 (female) Patient 4 (female) Before OP After OP Before OP After OP Before OP After OP Before OP After OP IPSS (score range)     Total 0 10 0 2 0 9 0 12     1. Incomplete emptying (0–5) 0 2 0 1 0 4 0 4     2. Frequency (0–5) 0 2 0 1 0 1 0 2     3. Intermittency (0–5) 0 1 0 0 0 2 0 2     4. Urgency (0–5) 0 1 0 0 0 0 0 1     5. Week stream (0–5) 0 1 0 0 0 0 0 0     6. Straining (0–5) 0 2 0 0 0 2 0 3     7. Nocturia (0–5) 0 1 0 0 0 0 0 0 IIEF (score range)      Total 75 44 – – – – – –     1. Erection function (1–30) 30 18 – – – – – –     2. Orgasmic function (0–10) 10 6 – – – – – –     3. Sexual desire (2–10) 10 6 – – – – – –     4. Intercourse satisfaction (0–15) 15 7 – – – – – –     5. Overall satisfaction (2–10) 10 7 – – – – – – FSFI     Total – – 95 58 95 27 95 32     1. Desire (2–10) – – 10 8 10 4 10 5     2. Arousal (0–20) – – 20 12 20 5 20 6     3. Lubrication (0–20) – – 20 10 20 6 20 6     4. Orgasm (0–15) – – 15 9 15 3 15 4     5. Satisfaction (2–15) – – 15 9 15 3 15 5     6. Pain (0–15) – – 15 10 15 6 15 6 IIEF, International Index of Erectile Function; FSFI, Female Sexual Function Index. DISCUSSION 1 2 2 24 10 11 15 In the present study, 6 patients (5.8%) had transient voiding disorder, 4 (9.1%) of 44 male patients had ejaculatory disorder, and up to 14.3% (6 of 42) female patients had sexual problems after the operation, even though their sympathetic nerves were successfully preserved during surgery. Our explanations for this phenomenon were as follows: first, anatomically, the inferior mesenteric plexus, thoracolumbar sympathetic splanchnic nerves, and superior hypogastric plexus were grossly manifested as a continuous plate of weblike connective tissues underlying the root of IMA and overlying the lower abdominal aortic and the interiliac trigone area. Therefore, some minor partial injury of nerve fibers may not be detected during surgery. Second, the retroperitoneal dissection by electrocauterization sometimes causes side injury and/or ischemia change of nerve fibers and thus compromised the neurophysiologic function. Third, the sexual function is influenced by various psychosocial factors. For example, the alteration of body image and/or bowel function after the operation may also have negative effect on sexual function. 21 22 In conclusion, the genitourinary function of patients can be successfully preserved with good technical efficiency during laparoscopic sigmoidectomy. The present study should facilitate further study regarding the impact of preservation of genitourinary function on the postoperative quality of life for patients with sigmoid colon cancer. Electronic supplementary material Below is the link to the electronic supplementary material.
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