***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background Sexual and urinary dysfunction is an established risk after pelvic surgery . Studies examining sexual and urinary function following laparoscopic and open rectal surgery give conflicting evidence for outcomes . The purpose of this study was to analyse the impact of the surgical technique on functional outcomes following laparoscopic or open resection for rectal cancer patients in a high-volume laparoscopic unit . Methods All patients who underwent elective laparoscopic or open surgery for rectal cancer between September 2006 and September 2009 were identified from a prospect ively collated data base . Vali date d st and ardized postal question naires were sent to surviving patients to assess their postoperative sexual and urinary function . The functional data were then quantified using previously vali date d indices of function . Results A total of 173 patients were identified from the data base , of whom 144 ( 83 % ) responded to the question naire-based study . Seventy-eight respondents had undergone laparoscopic rectal resection ( 49 men and 29 women ) , and 65 had an open procedure ( 41 men and 24 women ) . Both open surgery and laparoscopic surgery were associated with deterioration in urinary and sexual function . With regard to urinary function , there was no difference in the deterioration in open and laparoscopic groups in either gender . With regard to sexual function , in males one component of sexual function , namely , the incidence of successful penetration , showed less deterioration in the laparoscopic group ( p = 0.04 ) . However , in females , laparoscopic surgery was associated with significantly better outcomes in all aspects of sexual activity , specifically sexual arousal ( p = 0.005 ) , lubrication ( p = 0.001 ) , orgasm ( p = 0.04 ) , and the incidence of dyspareunia ( p = 0.02 ) . Conclusion Laparoscopic total mesorectal excision for rectal cancer is associated with significantly less deterioration in sexual function compared with open surgery . This effect is particularly pronounced in women Bladder and sexual dysfunction , secondary to pelvic nerve injury , are recognized complications of rectal resection . This study investigated the frequency of these complications following  laparoscopically assisted and conventional open mesorectal resection for cancer Objective To assess long-term quality of life in a population -based sample of rectal cancer patients . Summary Background Data Quality of life in rectal cancer patients who suffer reduced bowel and sexual function is very important . Few studies , however , have long term follow-up data or sufficient sample sizes for reliable comparisons between operation groups . Patients and Methods A 4-year prospect i ve study of rectal cancer patients ’ quality of life was assessed by using the European Organization for Research and Treatment of Cancer QLQ-30 and CR38 question naires . Results A total of 329 patients returned question naires . Overall , anterior resection patients had better quality of life scores than abdominoperineal extirpation patients . High-anterior resection patients had significantly better scores than both low-anterior resection and abdominoperineal extirpation patients . Low-anterior resection patients , however , overall had a better quality of life than abdominoperineal extirpation patients , especially after 4 years . Abdominoperineal extirpation patients ’ quality of life scores did not improve over time . Stoma patients had significantly worse quality of life scores than nonstoma patients . Quality of life improved greatly for patients whose stoma was reversed . Conclusions Anterior resection and nonstoma patients , despite suffering micturition and defecation problems , had better quality of life scores than abdominoperineal extirpation and stoma patients . Comparisons between abdominoperineal extirpation and anterior resection patients should consider the effect of temporary stomas . Improvements in quality of life scores over time may be explained by reversal of temporary stomas or physiologic adaptation Only few studies have investigated the impact of  surgery for rectal cancer on sexual function . Little of that research included quality of life ( QoL ) aspects and hardly any study analyzed the impact of age , gender and type of surgery on sexual function . The aim of the presented study was to address these issues . Over a 5 y period , EORTC-QLQ-C-30 and a tumor-specific module were prospect ively administered to patients before surgery , at discharge , 3 , 6 , 12 and 24 months postoperatively . Comparisons were made between patients receiving  abdominoperineal resection ( APR ) , anterior resection ( AR ) with or without Pouch and Sigmoid resection . Furthermore , effects of surgery on female and male patients , and age groups were analyzed . A total of 819 patients participated in the study : 412 were males and 407 were females . The groups were comparable in terms of adjuvant treatment , tumor stage and histology . Patients after APR and AR with Pouch had worst sexual function . Men reported significantly more difficulties with sexual enjoyment ; furthermore , over time , sexual problems created high levels of strain in men that were worse than baseline levels in the early postoperative period . These problems tended to remain . Patients aged 69 y and younger scored higher for problems with loss of sexual function and sexuality-related strain than patients aged 70 y and older . The findings in this study confirm that QoL changes postsurgery and that factors like type of surgery , gender and age have tremendous impact on sexual function and sexual enjoyment . APR and AR with Pouch affect sexual function more than AR and resection of the lower sigmoid . Through impaired sexual enjoyment , men are put more under strain than women . Patients aged 69 y and younger experience more stress through deteriorated sexual function Background Sexual function may be harmed after treatment for rectal cancer . This study aim ed to evaluate prospect ively the incidence of sexual dysfunction after rectal cancer treatment and to compare the effects of laparoscopic and traditional open approaches in terms of postoperative sexual function . Methods Baseline and 3- , 6- , and 12-month assessment s of sexual dysfunction using the International Index of Erectile Function ( IIEF ) and its specific domains prospect ively took place for 56 patients who underwent rectal cancer surgery ( 38 open vs. 18 laparoscopic procedures , 38 low anterior vs. 18 abdominoperineal resections ) . The preliminary results are presented . Results The average total IIEF and isolated IIEF response domain scores were significantly decreased after surgery ( p < 0.01 ) except for the intercourse satisfaction and overall satisfaction scores at 12 months . An improvement in IIEF scores was observed between the 3- and 6-month assessment points ( p < 0.01 ) except for the erectile function and orgasmic function scores . No significant differences were observed between the open and laparoscopic groups in the total IIEF and domain scores preoperatively and at the 3- and 6-month assessment points . The rates of sexual dysfunction did not differ significantly preoperatively or at 3 months postoperatively when open and laparoscopic procedures were compared , although there was a trend in favor of laparoscopic surgery at 6 months ( p = 0.076 ) . The baseline IIEF score and the baseline , 3- , and 6-month sexual desire scores were better ( p = 0.035 , 0.004 , 0.017 , and 0.061 , respectively ) in the low anterior resection group than in the abdominoperineal resection group . Conclusions Rectal cancer resections were postoperatively associated with a significant reduction in IIEF scores and high rates of sexual dysfunction at 3 and 6 months . The IIEF and domain scores at different assessment points were comparable between the laparoscopic and open surgery groups . Extending the monitoring period and adding more patients in this ongoing prospect i ve study will further eluci date postoperative sexual dysfunction after rectal cancer surgery AIMS To evaluate the health-related quality of life ( HRQoL ) outcomes in patients undergoing laparoscopic total mesorectal excision ( LTME ) with anal sphincter preservation ( ASP ) for low rectal cancers . METHODS Patients undergoing LTME with ASP or open procedures ( OTME ) for low rectal cancers were prospect ively followed up . All patients were treated in curative attempt and were free of local recurrence during the study . HRQoL was assessed by question naires during 3 - 6 months , 12 - 18 months , and 2 - 5 years after surgery . RESULTS From June 2001 to March 2006 , 125 patients undergoing LTME and 103 undergoing OTME were included in this study . In contrast to OTME patients , the LTME ones showed significantly better physical function during 3 - 6 months after surgery , less micturition problems within 12 - 18 months , less male sexual problems and better sexual function during 12 - 18 months after surgery , with better sexual enjoyment after 24 months postoperatively . Both groups showed significant improvement in most subscales from the first to the second assessment , and an improvement in sexual enjoyment from the second to the third assessment . The sexual function , micturition problems and male sexual problems in the LTME group significantly improved from the first to the second assessment , whereas the sexual function in the OTME group improved from the second to the third assessment . CONCLUSIONS Patients undergoing LTME for low rectal cancers can achieve superior postoperative HRQoL than patients undergoing OTME  , with superior physical function , micturition function , overall sexual and male sexual functions in the short term , and better sexual enjoyment in the long term . The HRQoL of both LTME and OTME patients may be expected to improve over time , particularly over the first postoperative year BACKGROUND The safety and short-term efficacy of laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy has not been demonstrated . The aim of the r and omised Comparison of Open versus laparoscopic surgery for mid and low REctal cancer After Neoadjuvant chemoradiotherapy ( COREAN ) trial was to compare open surgery with laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy . METHODS Between April 4 , 2006 , and Aug 26 , 2009 , patients with cT3N0 - 2 mid or low rectal cancer without distant metastasis after preoperative chemoradiotherapy were enrolled at three tertiary-referral hospitals . Patients were r and omised 1:1 to receive either open surgery ( n=170 ) or laparoscopic surgery ( n=170 ) , stratified according to sex and preoperative chemotherapy regimen . Short-term outcomes assessed were involvement of the circumferential resection margin , macroscopic quality of the total mesorectal excision specimen , number of harvested lymph nodes , recovery of bowel function , perioperative morbidity , postoperative pain , and quality of life . Analyses were based on the intention-to-treat population . Patients continue to be followed up for the primary outcome ( 3-year disease-free survival ) . This study is registered with Clinical Trials.gov , number NCT00470951 . FINDINGS Two patients ( 1.2 % ) in the laparoscopic group were converted to open surgery , but were included in the laparoscopic group for analyses . Estimated blood loss was less in the laparoscopic group than in the open group ( median 217.5 mL [ 150.0 - 400.0 ] in the open group vs 200.0 mL [ 100.0 - 300.0 ] in the laparoscopic group , p=0.006 ) , although surgery time was longer in the laparoscopic group ( mean 244.9 min [ SD 75.4 ] vs 197.0 min [ 62.9 ] , p<0.0001 ) . Involvement of the circumferential resection margin , macroscopic quality of the total mesorectal excision specimen , number of harvested lymph nodes , and perioperative morbidity did not differ between the two groups . The laparoscopic surgery group showed earlier recovery of bowel function than the open surgery group ( time to pass first flatus , median 38.5 h [ 23.0 - 53.0 ] vs 60.0 h [ 43.0 - 73.0 ] , p<0.0001 ; time to resume a normal diet , 85.0 h [ 66.0 - 95.0 ] vs 93.0 h [ 86.0 - 121.0 ] , p<0.0001 ; time to first defecation , 96.5 h [ 70.0 - 125.0 ] vs 123 h [ 94.0 - 156.0 ] , p<0.0001 ) . The total amount of morphine used was less in the laparoscopic group than in the open group ( median 107.2 mg [ 80.0 - 150.0 ] vs 156.9 mg [ 117.0 - 185.2 ] , p<0.0001 ) . 3 months after proctectomy or ileostomy takedown , the laparoscopic group showed better physical functioning score than the open group ( 0.501 [ n=122 ] vs -4.970 [ n=128 ] , p=0.0073 ) , less fatigue ( -5.659 [ n=122 ] vs 0.098 [ n=129 ] , p=0.0206 ) , and fewer micturition ( -2.583 [ n=122 ] vs 4.725 [ n=129 ] , p=0.0002 ) , gastrointestinal ( -0.400 [ n=122 ] vs 4.331 [ n=129 ] , p=0.0102 ) , 
    Output:
    
The available data are limited , but suggest that neither form of surgical approach be it laparoscopy or open surgery demonstrate superiority in preservation of sexual and bladder function .