Mercieca-Bebber, R.Eggins, R.Brown, K.Gebski, V.J.Brewer, K.Lai, L.Bailey, L.Solomon, M.J.Lumley, J.W.Hewett, P.Clouston, A.D.Wilson, K.Hague, W.Hayes, J.White, S.Morgan, M.Simes, R.J.Stevenson, A.R.L.2025-07-172025-07-172023Annals of Surgery, 2023; 277(3):449-4550003-49321528-1140https://hdl.handle.net/2440/146084Objective: The aim of this study was to compare patient-reported urinary, bowel, and sexual functioning of ALaCaRT Trial participants randomized to open or laparoscopic surgery for rectal cancer. Summary Background Data: The primary endpoint, noninferiority of laparoscopic surgical resection adequacy, was not established. Methods: Participants completed QLQ-CR29 at baseline, 3, and 12 months post-surgery. Additionally, women completed Rosen’s Female Sexual Functioning Index (FSFI). Men completed the International Index of Erectile Function (IIEF) and QLQ-PR25. We compared the proportions of participants in each group who experienced moderate/severe symptoms/dysfunction at each time-point and compared mean difference scores from baseline to 12 months between groups. All analyses were intention-to-treat. Sexual functioning analyses included only the participants who expressed sexual interest at baseline. Results: Baseline PRO compliance of 475 randomized participants was 88%. At 12 months, a lower proportion of open surgery participants experienced moderate–severe fecal incontinence and sore skin, compared to Laparoscopic participants, and a lower proportion of men randomized to open surgery experienced moderate–severe urinary symptoms. There were no differences at 3 months for bowel or urinary symptoms. Sexual functioning among sexually interested participants was similar between groups at 3 and 12 months; however, a lower proportion of women reported moderate to severe sexual dissatisfaction at 3 months in the open as compared to the laparoscopic group, (Rebecca.mercieca@sydney.edu.au., 95% CI 0.03–0.39). Discussion: Despite the slightly lower proportions of open surgery participants self-reporting moderate-severe symptoms for 3 of 16 urinary/bowel domains, and lack of differences in sexual domains, it remains difficult to recommend one surgical approach over another for rectal resection.enCopyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.Clinical trial, laparoscopic surgery, laparoscopic-assisted rectal cancer resection, open rectal cancer resection, patient-reported outcomes, quality of life, rectal cancer, sexual functioningRectumHumansRectal NeoplasmsLaparoscopyFemaleMalePatient Reported Outcome MeasuresProctectomyJournal article10.1097/SLA.0000000000005412652503