PRESERVATION OF MALE SEXUAL FUNCTION FOLLOWING ABDOMINOPERINEAL RESECTION FOR LOWER RECTAL ADENOCARCINOMA: CLINICAL CONSIDERATIONS AND SURGICAL STRATEGIES

Аннотация

Abdominoperineal resection (APR) remains a standard surgical approach for patients with low rectal adenocarcinoma when sphincter preservation is not oncologically feasible. Despite its effectiveness in achieving local disease control, APR is associated with a high incidence of postoperative male sexual dysfunction, primarily erectile dysfunction and ejaculatory disorders. These complications arise mainly from injury to the pelvic autonomic nervous system during deep pelvic dissection. This article reviews the anatomical and pathophysiological mechanisms underlying sexual dysfunction after APR, evaluates nerve-sparing surgical strategies, and summarizes clinical evidence on functional outcomes. A narrative analysis of published clinical studies indicates that preservation of the hypogastric nerves and pelvic plexus significantly improves postoperative sexual function without compromising oncologic radicality in selected patients. Comprehensive preoperative assessment and structured postoperative rehabilitation are essential components of patient-centered care. Integrating nerve-sparing principles into APR, when oncologically safe, can mitigate sexual morbidity and improve long-term quality of life.