Impact of Abdominoperineal Resection on Postoperative Male Sexual Function After Minimally Invasive Rectal Cancer Surgery: A Subgroup Analysis From the LANDMARC Study

Aim: Using data from the LANDMARC study, we aimed to evaluate the impacts of abdominoperineal resection (APR) on postoperative sexual function in males with rectal cancer undergoing minimally invasive surgery. Methods: = 59). Sexual function was assessed preoperatively and at 3, 6, and 12 months postoperatively using the International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS), and a customized questionnaire for ejaculatory function. Propensity score-based logistic regression models and longitudinal analyses were applied to address significant baseline imbalances. Results: In the overall cohort, APR was independently associated with significantly impaired erectile function. Adjusted models showed higher predicted probabilities of erectile dysfunction (ErD) after APR at 3 months (38.7% vs. 16.8) and 12 months (34.7% vs. 13.7%). Longitudinal analyses confirmed increased odds of ErD at 3 months (OR 2.86; 95% CI 1.25-6.53) and 12 months (OR 3.05; 95% CI 1.30-7.14). Potency impairment was also significantly more frequent at 3 months. Ejaculatory dysfunction was more common after APR early postoperatively. In patients with tumors located < 5 cm from the anal verge, APR remained associated with impaired erectile function, whereas ejaculatory function showed partial recovery. Conclusion: Results suggest that APR is associated with a high risk of postoperative sexual dysfunction, even in minimally invasive surgery. Sexual function preservation is an important consideration when APR is considered.