The first session at ESCP’s Virtually Vilnius did not disappoint. Hosted by Tina Van Loon (The Netherlands) and Des Winter (Ireland), the symposium on ‘Gender Influences on Colorectal Cancer Treatment’ featured a range of exciting topics and speakers from across Europe.

Kicking off the presentations was Thilo Wedel (Germany), who talked us through the anatomy of pelvic nerves. Thilo outlined through highly visual materials which nerves should be preserved within the pelvic capacity and asked the important question ‘Is there a gender difference in pelvic nerves?’

He reminded viewers that the impact of colorectal cancer treatment on women is often neglected and that we tend to focus on the male anatomy when looking at treatment options. But with 50% of patients being female, this is something that needs to be addressed and changed.

Pelvic automatic nerves: schematic overview slide

Thilo highlighted that, while overall pelvic anatomy is very similar between males and females, and there is not a great amount of difference in the pelvic nerves, the biggest difference lies in the fact that sexual and bladder functional outcomes in females are much less well-reported than in males, and this is something that needs to be taken into consideration by surgeons. He also made the interesting point that coloproctologists can look to learn from other specialist colleagues, such as gynaecologists, as they have the same overall goals to follow with their medical treatment.

After Thilo’s brilliant remarks, our focus was then turned to Anne Thyø (Denmark) who, with her team, is behind the largest investigated cohort about sexual function. She gave her talk ‘Preserving sexual function in rectal cancer treatment options’.

“We must never underestimate the negative impact that many treatment options can have on sexuality” she started, before noting that one of the many problems in recording the negative impact that surgery can have on a person’s sexuality is that there is a very low response rate in patient surveys of this kind.

Anne outlined several risk factors that should be considered before surgery. For example, radiotherapy and a permanent stoma were highlighted among some of the biggest reasons for sexual dysfunction after surgery, and the physical reasons which differ between men and women. But even if a TME procedure is correctly performed, and there is no use of stoma or radiotherapy, some patients will still experience sexual problems, and this is largely down to psychological factors, anxiety and an altered sexual self-image.

Can we preserve sexual function? presentation slide

While sexual dysfunction can massively impact a person’s health and wellbeing, surgery is still the cornerstone of rectal cancer treatment. All treatment options should nonetheless be discussed with the patient as some may be willing to sacrifice a lot for curative treatment, while others are not. Anne wrapped up her talk by reminding us all that, for patients that have lost their sexual function following surgery, proper counsel should be provided for after their treatment.

Plastic surgeon, Shan Shan Qiu Shao (The Netherlands), then gave her talk on ‘Pelvic floor / vaginal reconstruction after abdominoperineal excision’ and talked viewers through a detailed video which outlined how to operate using VY Flaps.

Shan showed step-by-step how to construct the VY form before explaining the advantages which included no need to change the patients position during surgery, and the strong vascularity in this area – and the complications, noting wound dehiscence and leakage.

VY Flap advantages slide

Kenny Rodriguez-Wallberg (Sweden) closed this session, presenting ‘Preservation of fertility options, surgical considerations (Cryo preservation and best practise)’. Kenny talked viewers through data that the Karolinska University Hospital has been collecting since 1988 for men, and 1998 for women, on cancer patients who have undergone fertility preservation.

Cancer patients who have undergone fertility preservation slide

We learned that there has been a far greater number of cases where men have undergone fertility preservation because it is a much easier and cheaper process for them. Whereas for women, it is far more involved for a number of reasons, for example, their eggs must be picked and helped to be developed. While Kenny shared the good news that there have been successful cases where children have been born after transplantation of ovarian tissue, she remarked that more needs to be done for effective and safe methods to be made equally accessible for men and women as they suffer equally with infertility.

Surgical procedures slide

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