A systematic review of female sexual function after surgery for locally advanced or recurrent colorectal cancer – first step to filling the knowledge gap

Abstract Aim Locally advanced and recurrent colorectal cancer can require extended surgery, including reconstruction of the vagina. This complex surgery carries high morbidity. The aim of this study was to analyse the impact on female sexual functioning of pelvic exenteration (PE), with or without vaginal flap reconstruction, for locally advanced or recurrent colorectal cancer. Method The protocol with search strategies for PubMed (Medline), EMBASE and the Cochrane Library was registered in PROSPERO. Studies published from 2000 onwards meeting the inclusion criteria were considered. Study selection (Rayyan), data extraction, rating of evidence (GRADE) and risk of bias (ROBINS‐I) were conducted independently by two reviewers. Results Six of 2479 identified records were included: four retrospective and two cross‐sectional studies. Of all 860 patients included, PE was performed in 314 patients. Seven hundred and thirty‐two had rectal cancer (85.1%), 80 nonadvanced rectal cancer (10.9%), 393 locally advanced rectal cancer (53.7%) and 217 locally recurrent rectal cancer (29.6%); for 45 patients the type of rectal cancer remained unspecified (6.1%). Three studies reported on both preoperative and postoperative female sexual activity. Of the 153 women who were sexually active preoperatively, 64 (41.8%) reported postoperative sexual activity. The VRAM flap was used the most frequently and resulted in a sexual activity ratio of 18% postoperatively. Four studies, using six different validated questionnaires, reported mostly lowered sexual functioning postoperatively. Conclusion Most studies showed that PE can result in severe sexual dysfunction despite reconstruction. Future prospective studies can fill the current knowledge gap by assessing long‐term sexual outcomes in women.