ヤマグチ　シゲキ   YAMAGUCHI Shigeki   山口　茂樹    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Risk factors for male sexual dysfunction after minimally invasive surgery for rectal cancer: a multicenter prospective subanalysis of the LANDMARC study
掲載誌名	正式名：Surgical endoscopy 略　 称：Surg Endosc ISSNコード：14322218/09302794
掲載区分	国外
巻・号・頁	40(2),pp.945-954
著者・共著者	SAKURAI Tsubasa,YAMAGUCHI Tomohiro,NUMATA Masakatsu,SAKAMOTO Takashi,HIDA Koya,AKAGI Tomonori,SHIOMI Akio,INADA Ryo,SHIOZAWA Manabu,KAZAMA Keisuke,HOTCHI Masanori,YAMAMOTO Daisuke,HASEGAWA Suguru,MIGUCHI Masashi,OHNUMA Shinobu,UEHARA Kay,MUNAKATA Koji,HORIE Hisanaga,MIYAKE Toru,TAKAHASHI Hiroki,FURUTANI Akinobu,MATOBA Shuichiro,SAKAMOTO Kazuhiro,KAGAWA Hiroyasu,KINUGASA Yusuke,YAMAGUCHI Shigeki,WATANABE Masahiko,NAITOH Takeshi
発行年月	2026/02
概要	BACKGROUND:Sexual dysfunction (SD) is a recognized complication of rectal cancer surgery, even minimally invasive surgery (MIS), and can significantly impact postoperative quality of life. This study aimed to identify risk factors for SD and develop a predictive nomogram in a multicenter prospective setting.METHODS:This sub-analysis of the LANDMARC study initially enrolled 399 male patients who underwent laparoscopic (Lap) or robotic (Ro) rectal cancer surgery at 49 Japanese institutions between December 2019 and October 2022. After excluding patients who underwent transanal total mesorectal excision, total pelvic exenteration, prostate or seminal vesicle resection, surgical conversion, preoperative SD, or incomplete SD assessment, 300 patients were included in the final analysis. SD was defined as the presence of either erectile dysfunction or ejaculation dysfunction at 12 months postoperatively based on patient-reported questionnaires.RESULTS:SD was observed in 129 (43.0%) patients. Multivariate analysis identified advanced age (odds ratio [OR]: 1.041; p = 0.01) and the Lap approach (compared with Ro surgery; OR: 1.795; p = 0.02) as independent risk factors for SD. A nomogram was constructed using variables selected by Least Absolute Shrinkage and Selection Operator regression. The model demonstrated modest discriminative ability (area under the curve: 0.672) with reasonable calibration in the intermediate-risk group.CONCLUSIONS:Advanced age and Lap surgery were associated with an increased risk of postoperative SD after MIS for rectal cancer. Therefore, Ro surgery may offer protective advantages. Although the predictive accuracy of the nomogram was limited, it may aid preoperative counseling and raise awareness of postoperative sexual outcomes.
DOI	10.1007/s00464-025-12345-5
PMID	41168470