Platteau Elke, Denys Andreas, Buncamper Prof. Marlon, van Ramshorst Prof. Gabriëlle

(122) FEMALE SEXUAL FUNCTION AFTER PELVIC EXENTERATION FOR LOCALLY ADVANCED OR RECURRENT COLORECTAL CANCER: A SYSTEMATIC REVIEW

  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health
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Abstract Objectives Our objective was to analyze the impact of pelvic exenteration (PE) and vaginal flap reconstruction on the sexual functioning of women with locally advanced or recurrent colorectal cancer. Methods A protocol was registered in PROSPERO. PubMed, Embase and Cochrane Library were searched using protocolized search strategies. Studies published between January 2000 and October 2021 reporting on sexual function for at least 5 female PE patients were considered eligible. Study selection, data extraction, rating of certainty of evidence (GRADE) and risk of bias (ROBINS-I) were conducted independently by two reviewers. Results Seven of 2086 studies were included. The 5 retrospective and 2 cross-sectional studies were of very low quality, with an overall serious risk of bias. Of all 1221 patients, PE was performed in 683 patients. The VRAM-flap was used in 95,3% of 297 women undergoing reconstruction. 393 patients had locally advanced rectal cancer, 217 had recurrent rectal cancer and for the other patients the cancer type was not specified. Six different validated questionnaires were used in 4 different studies to evaluate female quality of life and sexual function, including the EORTC QLQ-CR29, EORTC QLQ-C30, EORTC QLQ-CR38, FSFI, SF-36v2 and SVQ. All studies included data on female sexual activity, with 3 studies reporting on both baseline and postoperative sexual activity. 41,8% (n= 64/153) of preoperative sexual active women, were still sexual active postoperative. The VRAM-flap was proven to be a suitable technique to close perineal and/or vaginal defects, with a low rate of major complications. Conclusions This study shows that oncologic resection including pelvic exenteration leads to grave sexual dysfunction despite vaginal reconstruction with the use of a VRAM-flap. Data concerning sexual function after reconstruction for vaginal resection are limited, with lack of a standard protocol to evaluate female sexual function making it difficult to compare treatment results between studies. Conflicts of Interest All authors declare that they have no conflicts of interest.

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