Background/Objectives: With advances in surgical techniques for rectal cancer—particularly laparoscopic and robotic-assisted approaches—the 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.

Backround/Objectives: Colorectal cancer presents a significant quality of life (QoL) challenge as a result of both the disease and its treatments. This study aimed to validate and culturally adapt the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) for Serbian-speaking colorectal cancer patients. Methods: The CCF-CaQL offers a detailed assessment of the physical, emotional, social, and functional impacts of the disease. This study, conducted at the University Clinical Center of Serbia, involved 150 colorectal cancer patients undergoing treatment. The translation and adaptation process followed the EORTC Quality of Life Group’s guidelines, ensuring cultural relevance and comprehensibility. Statistical analyses, including Cronbach’s alpha for internal consistency and Pearson’s correlation for concurrent validity, reliability, and known-groups validity, were performed using SPSS and R software. Results: The Serbian version of the CCF-CaQL maintains strong psychometric properties with high internal consistency (Cronbach’s alpha = 0.85) and significant correlations with the FACT-C questionnaire, confirming its validity. Known-groups validity showed distinct variations in QoL scores based on tumor location, stoma presence, and neoadjuvant therapy status, highlighting its sensitivity to different clinical conditions. Conclusions: The CCF-CaQL questionnaire has been skillfully translated, culturally adapted, and carefully validated through psychometric evaluations for Serbian patients diagnosed with colorectal cancer.