Exploratory Analysis of Factors Associated With the Recovery of Erectile Dysfunction After Rectal Cancer Surgery (Sub‐Analysis of LANDMARC Trial)

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Background: Erectile dysfunction (ErD) is an important complication after rectal cancer surgery, however a substantial proportion of patients experience functional recovery over time. Evidence regarding which patients are more likely to recover remains limited. This study aimed to identify factors associated with the recovery of postoperative ErD in male patients undergoing minimally invasive rectal cancer surgery. Methods: This study was a sub-analysis of the LANDMARC study, a multicenter prospective trial across 49 hospitals, including male patients who underwent minimally invasive surgery for middle or lower rectal cancer. Erectile function was assessed preoperatively and up to 12 months postoperatively using the Erection Hardness Score (EHS). Analyses focused on ErD at 3 months and recovery at 12 months postoperatively. Modified Poisson regression was used to explore factors associated with recovery. Results: Among 337 patients with complete data, postoperative ErD was observed in 136 patients (40%). Of these, 67 patients (49%) showed recovery of ErD at 12 months. Factors associated with the recovery of ErD were upper tumor location (RR: 1.51; 95% CI: 1.06, 2.16), pathological T stage ≤ 2 (RR: 1.59; 95% CI: 1.07, 2.38), absence of neoadjuvant chemotherapy (RR: 2.05; 95% CI: 1.01, 4.13), and creation of a diverting stoma (RR: 1.85; 95% CI: 1.21, 2.85). Sensitivity analyses using alternative recovery definitions showed consistent results, particularly for tumor location and diverting stoma. Conclusions: ErD after rectal cancer surgery is not always irreversible. These exploratory findings may help inform future studies aimed at developing individualized penile rehabilitation strategies after rectal cancer surgery.

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