{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:00:22Z","timestamp":1787500822743,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science, Technological Development and Innovation of the Republic of Serbia","award":["451-03-137\/2025-03\/200110"],"award-info":[{"award-number":["451-03-137\/2025-03\/200110"]}]},{"name":"Ministry of Science, Technological Development and Innovation of the Republic of Serbia","award":["451-03-33\/2026-03\/200110"],"award-info":[{"award-number":["451-03-33\/2026-03\/200110"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: With advances in surgical techniques for rectal cancer\u2014particularly laparoscopic and robotic-assisted approaches\u2014the choice of operative method may influence not only oncological but also functional outcomes. This study aimed to compare open and laparoscopic rectal cancer surgery regarding pelvic autonomic nerve identification, preservation and its impact on postoperative urinary, sexual, and quality-of-life outcomes. Methods: A total of 181 patients who underwent curative rectal cancer surgery at the Clinic for Digestive Surgery, University Clinical Center of Serbia, were included. Six types of procedures were performed using both open and laparoscopic approaches. Intraoperative identification and preservation of pelvic autonomic nerves were assessed and verified postoperatively through evaluation of urinary, sexual, and quality-of-life parameters. Urinary function and related life quality were assessed using the International Prostate Symptom Score (IPSS and IPSS-QoL), while sexual function was evaluated using gender-specific validated questionnaires (IIEF-15 and FSFI) preoperatively and at 2, 4, and 6 months postoperatively. Results: Nerve non-visualization and\/or injuries were significantly more frequent in the open surgery group. The laparoscopic approach was associated with better preservation of urinary function, particularly among male patients, better sexual function in both sexes, and a transient advantage in quality of life. Conclusions: Laparoscopic rectal cancer surgery demonstrated superior pelvic autonomic nerve visualization and preservation and better short-term urinary and sexual function. Nonetheless, quality-of-life outcomes were comparable by 6 months of follow-up, underscoring the importance of meticulous nerve-preserving technique regardless of surgical approach.<\/jats:p>","DOI":"10.3390\/jcm15062421","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T09:48:42Z","timestamp":1774259322000},"page":"2421","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Open vs. Laparoscopic Surgery for Rectal Cancer: Impact on Identification and Preservation of Pelvic Autonomic Nerves and Effects on Urinary and Sexual Function and Quality of Life"],"prefix":"10.3390","volume":"15","author":[{"given":"Ivan","family":"Dimitrijevic","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Miladinov","sequence":"additional","affiliation":[{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelenko","family":"Jelenkovic","sequence":"additional","affiliation":[{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Predrag","family":"Gavrilovic","sequence":"additional","affiliation":[{"name":"Center for Medical Informatics, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3585-2612","authenticated-orcid":false,"given":"Aleksandar","family":"Sekulic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goran","family":"Barisic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6557-0010","authenticated-orcid":false,"given":"Jovana","family":"Rosic Stojkovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1001\/archsurg.133.8.894","article-title":"Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978\u20131997","volume":"133","author":"Heald","year":"1998","journal-title":"Arch. 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