# Open vs. Laparoscopic Surgery for Rectal Cancer: Impact on Identification and Preservation of Pelvic Autonomic Nerves and Effects on Urinary and Sexual Function and Quality of Life

## TL;DR

This study compares open and laparoscopic rectal cancer surgeries, finding that laparoscopic approaches better preserve pelvic nerves and improve urinary and sexual function in the short term.

## Contribution

The study introduces a direct comparison of nerve preservation and functional outcomes between open and laparoscopic rectal cancer surgeries.

## Key findings

- Laparoscopic surgery showed better pelvic autonomic nerve visualization and preservation.
- Laparoscopic surgery improved short-term urinary function in males and sexual function in both sexes.
- Quality-of-life outcomes were comparable by 6 months post-surgery between the two approaches.

## Abstract

Background/Objectives: With advances in surgical techniques for rectal cancer—particularly laparoscopic and robotic-assisted approaches—the choice of operative method may influence not only oncological but also functional outcomes. This study aimed to compare open and laparoscopic rectal cancer surgery regarding pelvic autonomic nerve identification, preservation and its impact on postoperative urinary, sexual, and quality-of-life outcomes. Methods: A total of 181 patients who underwent curative rectal cancer surgery at the Clinic for Digestive Surgery, University Clinical Center of Serbia, were included. Six types of procedures were performed using both open and laparoscopic approaches. Intraoperative identification and preservation of pelvic autonomic nerves were assessed and verified postoperatively through evaluation of urinary, sexual, and quality-of-life parameters. Urinary function and related life quality were assessed using the International Prostate Symptom Score (IPSS and IPSS-QoL), while sexual function was evaluated using gender-specific validated questionnaires (IIEF-15 and FSFI) preoperatively and at 2, 4, and 6 months postoperatively. Results: Nerve non-visualization and/or injuries were significantly more frequent in the open surgery group. The laparoscopic approach was associated with better preservation of urinary function, particularly among male patients, better sexual function in both sexes, and a transient advantage in quality of life. Conclusions: Laparoscopic rectal cancer surgery demonstrated superior pelvic autonomic nerve visualization and preservation and better short-term urinary and sexual function. Nonetheless, quality-of-life outcomes were comparable by 6 months of follow-up, underscoring the importance of meticulous nerve-preserving technique regardless of surgical approach.