Does neoadjuvant chemoradiotherapy increase the effect of lateral lymph node dissection on urogenital function?

BACKGROUND: It is unclear whether neoadjuvant chemoradiotherapy (nCRT) has a deleterious influence on urogenital function in rectal cancer patients who undergone lateral lymph node dissection (LLND). The purpose of this study was to determine the incidence of urogenital dysfunction following total mesorectal excision (TME) + LLND with or without nCRT for mid-low rectal cancer, as well as to investigate the factors that predict urogenital dysfunction. METHODS: From January 2015 to December 2020, a total of 106 consecutive patients who underwent TME + LLND surgery for mid-low rectal cancer were reviewed. Patients were divided into two groups based on whether they had undergone nCRT (n=51) or not (n=55). RESULTS: Overall, 106 patients responded to the questionnaires. nCRT was not associated with urinary dysfunction [International Prostatic Symptom Score (IPSS): 9.86 vs. 9.43, P=0.778; postoperative urinary dysfunction: 51.0% vs. 34.5%, P=0.087] or male sexual dysfunction [International Index Erectile Function (IIEF) score: 18.45 vs. 18.42, P=0.980; postoperative sexual dysfunction: 61.3% vs. 54.8%, P=0.607]. According to the univariable analyses, tumour distance from the anal verge ≤4 cm (P=0.029) and type of operation (P=0.020) were associated with an increased risk of urinary dysfunction; patients’ age (P=0.026) and type of LLND (P=0.044) were candidate risk factors for male sexual dysfunction. However, multivariable analyses showed that tumour distance from the anal verge was independently associated with urinary dysfunction (OR =2.505; 95% CI: 1.080–5.813; P=0.032); patients’ age was an independent risk factor for male sexual dysfunction (OR =3.654; 95% CI: 1.028–12.982; P=0.045). CONCLUSIONS: In rectal cancer patients who had LLND, nCRT showed no significant additive effect on genitourinary function as compared to individuals who had TME + LLND alone. Urinary dysfunction was linked to the distance between the tumor and the anal margin, while age was an independent predictor of sexual dysfunction.