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Rentiya ZS, Francis D, Francis SM, Inban P, Raj R, Akuma O, Akuma CM, Montecino RMB, Singh M, Makheja K, Parkash O, Kottoor SJ. The Management of a Urinary Bladder Leak in a Patient with Radiation Cystitis. Radiol Case Rep 2024; 19:2429-2433. [PMID: 38585403 PMCID: PMC10997864 DOI: 10.1016/j.radcr.2024.02.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Urinary dysfunction following treatment for rectal adenocarcinoma is a common and complex complication. We present a case of a 69-year-old male who underwent laparoscopic-assisted left hemicolectomy and loop ileostomy after receiving chemotherapy and radiation therapy for rectal adenocarcinoma. Postoperatively, it was incidentally discovered the patient had urinary frequency and urgency. Cystoscopy revealed radiation changes to the bladder walls and a bladder leak was confirmed by cystogram. The patient underwent successful repair of the urinary bladder leak, with challenges posed by prior radiation therapy. Effective prevention and management strategies for urinary dysfunction require a comprehensive preoperative risk assessment, consideration of nerve-preserving surgical techniques, and prompt identification and repair of postoperative complications.
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Affiliation(s)
- Zubir S. Rentiya
- University of Virginia, Department of Radiation Oncology & Radiology, Charlottesville, VA, USA
- MedStar Georgetown University Hospital, Department of Surgery, Washington, DC, USA
| | - Deepa Francis
- Windsor University School of Medicine, Department of Internal Medicine, Cayon, St. Kitts and Nevis
| | - Sandra Mary Francis
- Windsor University School of Medicine, Department of Internal Medicine, Cayon, St. Kitts and Nevis
| | | | - Rohan Raj
- Nalanda Medical College and Hospital, Department of Internal Medicine, Patna, India
| | - Ogbonnaya Akuma
- Ebonyi State University, Department of Internal Medicine, Abakaliki, Nigeria
| | - Chinaza Mercy Akuma
- Nnamdi Azikiwe University, Department of Internal Medicine, Awka, Anambra state, Nigeria
| | | | - Manjeet Singh
- Liaquat National Medical College, Department of Internal Medicine, Karachi, Pakistan
| | - Kainat Makheja
- Jinnah Sindh Medical University, Department of Internal Medicine, Karachi, Pakistan
| | - Om Parkash
- Chandka Medical College, Department of Internal Medicine, Larkana, Pakistan
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Randhawa SE, Tenner L. Survivorship in Early-Stage Rectal Cancer Patients Who Have Received Combined Modality Therapy. Clin Colorectal Cancer 2023; 22:375-382. [PMID: 37586927 DOI: 10.1016/j.clcc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
Survival rates in early-stage rectal cancer patients have increased over the past few decades. Societies such as the National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and European Society of Medical Oncology (ESMO) have proposed guidelines related to cancer survivorship care including formal recommendations to address the needs in early-stage rectal cancer survivors. These guidelines, in addition to new clinical research findings in survivorship will be reviewed, specifically looking at physical, psychosocial, and financial concerns in rectal cancer survivorship.
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Affiliation(s)
- Saboor E Randhawa
- Hematology and Medical Oncology Fellow, University of Nebraska Medical Center, Omaha, NE
| | - Laura Tenner
- Department of Gastrointestinal Oncology, University of Nebraska Medical Center, Omaha, NE.
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Kubota S, Miura T, Wakiya T, Yoshizawa T, Goto S, Morohashi H, Sakamoto Y, Tatara Y, Kijima H, Hakamada K. Exploration of Malignant Characteristics in Neoadjuvant Chemotherapy-Resistant Rectal Cancer, Focusing on Extramural Lesions. Ann Surg Oncol 2023; 30:7612-7623. [PMID: 37548833 PMCID: PMC10562322 DOI: 10.1245/s10434-023-13928-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/28/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Extramural vascular invasion (EMVI) and tumor deposits (TD) are poor prognostic factors in rectal cancer (RC), especially when resistant to neoadjuvant chemotherapy (NAC). We aimed to define differential expression in NAC responders and non-responders with concomitant EMVI and TD. METHODS From 52 RC surgical patients, post-NAC resected specimens were extracted, comprising two groups: cases with residual EMVI and TD (NAC-resistant) and cases without (NAC-effective). Proteomic analysis was conducted to define differential protein expression in the two groups. To validate the findings, immunohistochemistry was performed in another cohort that included 58 RC surgical patients. Based on the findings, chemosensitivity and prognosis were compared. RESULTS The NAC-resistant group was associated with a lower 3-year disease-free survival rate than the NAC-effective group (p = 0.041). Discriminative proteins in the NAC-resistant group were highly associated with the sulfur metabolism pathway. Among these pathway constituents, selenium-binding protein 1 (SELENBP1) expression in the NAC-resistant group decreased to less than one-third of that of the NAC-effective group. Immunohistochemistry in another RC cohort consistently validated the relationship between decreased SELENBP1 and poorer NAC sensitivity, in both pre-NAC biopsy and post-NAC surgery specimens. Furthermore, decrease in SELENBP1 was associated with a lower 3-year disease-free survival rate (p = 0.047). CONCLUSIONS We defined one of the differentially expressed proteins in NAC responders and non-responders, concomitant with EMVI and TD. SELENBP1 was suspected to contribute to NAC resistance and poor prognosis in RC.
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Affiliation(s)
- Shunsuke Kubota
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Tadashi Yoshizawa
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Shintaro Goto
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yota Tatara
- Department of Stress Response Science, Center for Advanced Medical Research, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hiroshi Kijima
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
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Abstract
IMPORTANCE AND OBJECTIVES Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women. METHODS This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia. FINDINGS Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists. CONCLUSIONS Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.
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Affiliation(s)
- Lauren F Streicher
- From the Northwestern Medicine Center for Sexual Medicine and Menopause, Northwestern Medicine, Chicago, IL
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Li X, Fu R, Ni H, Du N, Wei M, Zhang M, Shi Y, He Y, Du L. Effect of Neoadjuvant Therapy on the Functional Outcome of Patients With Rectal Cancer: A Systematic Review and Meta-Analysis. Clin Oncol (R Coll Radiol) 2023; 35:e121-e134. [PMID: 35940977 DOI: 10.1016/j.clon.2022.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/12/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
AIMS The impact of neoadjuvant therapy on the functional outcome of patients with resectable rectal cancer is still controversial. The aim of the present study was to explore the effects of neoadjuvant therapy on anorectal function (ARF), urinary function and sexual function in relevant patients. MATERIALS AND METHODS PubMed, Embase, Web of Science and the Cochrane Library were searched systematically. All English-language studies, published from January 2000 to July 2021, that explored the (postoperative) effects of neoadjuvant therapy versus upfront surgery on ARF, urinary function and sexual function of patients were included (PROSPERO 2021: CRD42021281617). RESULTS The data in this study were derived from 37 articles based on 33 studies; in total, 17 917 patients were enrolled. The meta-analysis revealed that the incidence of anorectal dysfunction in the neoadjuvant therapy group was significantly higher than that in the group of upfront surgery, which was manifested by a higher incidence of major low anterior resection syndrome (odds ratio = 3.09, 95% confidence interval = 2.48, 3.84; P < 0.001), reduction of mean squeeze pressure and mean resting pressure, and other manifestations, including clustering of stools, incontinence, urgency and use of pads. With the extension of follow-up time, the adverse effects of neoadjuvant therapy on major low anterior resection syndrome existed. Compared with patients undergoing upfront surgery, neoadjuvant therapy increased the risk of urinary incontinence (odds ratio = 1.31, 95% confidence interval = 1.00, 1.72; P = 0.05) and erectile dysfunction (odds ratio = 1.77, 95% confidence interval = 1.27, 2.45; P < 0.001). CONCLUSION Compared with upfront surgery, neoadjuvant therapy is not only associated with impairment of ARF, but also with increased incidence of urinary incontinence and male erectile dysfunction. However, the influence of confounding factors (e.g. surgical method, tumour stage) needs to be considered.
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Affiliation(s)
- Xiangyuan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haixiang Ni
- The Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Nannan Du
- Laboratory of Cell Engineering, Institute of Biotechnology, Beijing, China
| | - Mengfei Wei
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liwen Du
- Emergency Department, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
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Laohawiriyakamol S, Chewatanakornkul S, Wanichsuwan W, Ruangsin S, Sunpaweravong S, Bejrananda T. Urogenital dysfunction after laparoscopic surgery for rectal or sigmoid colon cancer. Asian J Surg 2023; 46:492-500. [PMID: 35717291 DOI: 10.1016/j.asjsur.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Urogenital dysfunction is a common complication after surgery for sigmoid colon or rectal cancers and may result from various causes. Herein, we evaluated urogenital dysfunction and the associated factors after laparoscopic surgery at different follow-up times. METHODS We conducted a prospective study on 91 patients who were diagnosed with sigmoid colon and rectal cancers and underwent laparoscopic surgery during 2014-2016. Voiding and male and female sexual dysfunctions following surgery were evaluated by the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Female Sexual Function Index-6 (FSFI-6), respectively. Urogenital function was compared at pre-surgery and 3 and 12 months postoperatively, and factors associated with urogenital dysfunction were identified. RESULTS The overall urinary function after surgery was better when compared to that at pre-surgery; however, there was deterioration in both male and female sexual functions. The mean preoperative IPSS, IIEF-5, and FSFI-6 scores were 9.35, 12.18, and 6.09, respectively. The mean differences among IPSS, IIEF-5, and FSFI-6 at 12 months postoperatively and pre-surgery were -3.08 (95% confidence interval [CI] -4.77 to -1.40), -2.57 (95% CI -4.33 to -0.80), and -2.58 (95% CI -4.73 to 0.42), respectively. Multivariate analysis demonstrated that age ≤60 years (odds ratio 4.22) and postoperative complications (odds ratio 2.77) were correlated with erectile dysfunction. CONCLUSION Voiding function improved after laparoscopic surgery in both sigmoid colon and rectal cancer patients. However, sexual function in both male and female patients was worse. Age ≤60 years and postoperative complications were strongly associated with male sexual dysfunction.
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Affiliation(s)
- Supparerk Laohawiriyakamol
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Siripong Chewatanakornkul
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Worawit Wanichsuwan
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Sakchai Ruangsin
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Somkiat Sunpaweravong
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Tanan Bejrananda
- Urologic Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Identification of Risk Factors for Sexual Dysfunction after Multimodal Therapy of Locally Advanced Rectal Cancer and Their Impact on Quality of Life: A Single-Center Trial. Cancers (Basel) 2022; 14:cancers14235796. [PMID: 36497279 PMCID: PMC9736520 DOI: 10.3390/cancers14235796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Sexual function is crucial for the quality of life and can be highly affected by preoperative therapy and surgery. The aim of this study was to identify potential risk factors for poor sexual function and quality of life. METHODS Female patients were asked to complete the Female Sexual Function Index (FSFI-6). Male patients were demanded to answer the International Index of Erectile Function (IIEF-5). RESULTS In total, 79 patients filled in the questionary, yielding a response rate of 41.57%. The proportion of women was represented by 32.91%, and the median age was 76.0 years (66.0-81.0). Sexual dysfunction appeared in 88.46% of female patients. Severe erectile dysfunction occurred in 52.83% of male patients. Univariate analysis showed female patients (OR: 0.17, 95%CI: 0.05-0.64, p = 0.01), older age (OR: 0.34, 95%CI 0.11-1.01, p = 0.05), tumor localization under 6cm from the anal verge (OR: 4.43, 95%CI: 1.44-13.67, p = 0.01) and extension of operation (APR and ISR) (OR: 0.13, 95%CI: 0.03-0.59, p = 0.01) as significant risk factors for poor outcome. Female patients (OR: 0.12, 95%CI: 0.03-0.62, p = 0.01) and tumors below 6 cm from the anal verge (OR: 4.64, 95%CI: 1.18-18.29, p = 0.03) were shown to be independent risk factors for sexual dysfunction after multimodal therapy in the multivariate analysis. Quality of life was only affected in the case of extensive surgery (p = 0.02). CONCLUSION Higher Age, female sex, distal tumors and extensive surgery (APR, ISR) are revealed risk factors for SD in this study. Quality of life was only affected in the case of APR or ISR.
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Surgical outcomes and sexual function after laparoscopic colon cancer surgery with transvaginal versus conventional specimen extraction: A retrospective propensity score matched cohort study. Int J Surg 2022; 104:106787. [DOI: 10.1016/j.ijsu.2022.106787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/02/2023]
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Morohashi H, Sakamoto Y, Miura T, Ichinohe D, Kubota S, Yamazaki K, Ichisawa A, Mitsuhashi Y, Wakiya T, Hakamada K. Short-term outcomes of robotic-assisted surgery following neoadjuvant chemotherapy for lower rectal cancer. Asian J Endosc Surg 2022; 15:577-584. [PMID: 35304815 DOI: 10.1111/ases.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There have been reports about robotic surgery for rectal cancer with chemoradiotherapy (CRT), but only a few studies have compared the use of robotic surgery with and without neoadjuvant chemotherapy (NAC). The aim of our study was to compare the perioperative outcomes of robotic surgery with and without NAC for lower rectal cancer and to examine the effects of NAC on robotic surgery. METHODS From January 2016 to July 2021, we compared the short-term outcomes of 45 patients who did not undergo NAC and 55 patients who underwent NAC. RESULTS The rate of sphincter-preserving surgeries was higher in the NAC group than in the non-NAC group (P = .024). The total operative time was significantly longer in the NAC group than in the non-NAC group (P < .001). The rate of lateral lymph node dissection was significantly higher in the NAC group than in the non-NAC group (P < .001). No significant differences were identified in the rate of incisional surgical site infections (SSI), organ/space SSI postoperative bleeding, small bowel obstruction, anastomotic leakage, urinary dysfunction, or urinary infections between the groups. There were eight incidences of lateral lymph node metastasis (15%) and two cases with positive resection margins (4.0%) in the NAC group. CONCLUSIONS Robotic surgery after NAC has few complications and a higher sphincter-preserving rate that without NAC.
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Affiliation(s)
- Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Daichi Ichinohe
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shunsuke Kubota
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Keisuke Yamazaki
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Aika Ichisawa
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yuto Mitsuhashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
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Early and Long-Term Outcomes after Propofol-and Sevoflurane-Based Anesthesia in Colorectal Cancer Surgery: A Retrospective Study. J Clin Med 2022; 11:jcm11092648. [PMID: 35566773 PMCID: PMC9103516 DOI: 10.3390/jcm11092648] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Propofol is considered to protect against immunosuppression and has lower inflammatory responses in the perioperative period than volatile agents. We evaluated whether the anesthetic agent is associated with cancer outcomes. Methods: We retrospectively reviewed 2616 patients who underwent colorectal cancer surgery under general anesthesia between 2016 and 2018 (follow-up closure: July 2021) at a single institution. Patients received propofol-based total intravenous anesthesia or sevoflurane-based inhalational anesthesia. After propensity score matching, the postoperative neutrophil-lymphocyte ratio (NLR) was compared as primary outcome, and clinical outcomes were evaluated. Results: After 1:2 propensity matching, 717 patients were given propofol anesthesia and 1410 patients were given sevoflurane anesthesia. In the matched cohort, preoperative NLR was not significantly different between propofol and sevoflurane anesthesia (mean (95% CI)2.3 (1.8 to 2.8) and 2.2 (1.9 to 3.2); p = 0.72). NLR was significantly lower in propofol anesthesia at postoperative day two and five (mean difference (95% CI) 0.71 (0.43 to 0.98); p = 0.000 and 0.52 (0.30 to 0.74); p = 0.000). Urinary retention showed a higher incidence after propofol anesthesia (4.9% vs. 2.6%; p = 0.008). Other postoperative complications and overall/recurrence-free survival were not different in the two groups. Discussion: Although propofol anesthesia showed lower postoperative NLR than sevoflurane anesthesia, there was no association with clinical outcomes.
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Sakamoto Y, Morohashi H, Miura T, Tsutsumi S, Takahashi S, Hirama K, Wakiya T, Hakamada K. A Prospective Multicenter Phase II Study on the Feasibility and Efficacy of S-1 and Oxaliplatin Neoadjuvant Chemotherapy for Locally Advanced Rectal Cancer. Dis Colon Rectum 2022; 65:663-671. [PMID: 33833145 DOI: 10.1097/dcr.0000000000001927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy and total mesorectal excision compose the standard of care for rectal cancer in multiple guidelines. However, neoadjuvant chemoradiotherapy has not exhibited clear survival benefits but rather has led to an increase in adverse events. Conversely, neoadjuvant chemotherapy is expected to prevent adverse events caused by radiation, yet this treatment is still controversial. OBJECTIVE The purpose of this study was to evaluate the feasibility and efficacy of S-1 and oxaliplatin neoadjuvant chemotherapy together with total mesorectal excision for resectable locally advanced rectal cancer. DESIGN The study was a prospective, single-arm phase II trial. SETTINGS The study was conducted at multiple institutions. PATIENTS Fifty-eight patients with resectable locally advanced rectal cancer were enrolled. INTERVENTION Three cycles of S-1 and oxaliplatin were administered before surgery. S-1 was administered orally at 80 mg/m2 per day for 14 consecutive days, followed by a 7-day resting period. Oxaliplatin was given intravenously on the first day at a dose of 130 mg/m2 per day. The duration of 1 cycle was considered to be 21 days. Total mesorectal excision with bilateral lymph node dissection was carried out after neoadjuvant chemotherapy. MAIN OUTCOME MEASURES The study was designed to detect the feasibility and efficacy of S-1 and oxaliplatin as neoadjuvant chemotherapy. RESULTS The completion rate of 3 courses of S-1 and oxaliplatin as neoadjuvant chemotherapy was 94.8% (55/58). The reasons for discontinuation were thrombocytopenia (3.4%) and liver injury (1.7%). The most common severe (grade ≥3) adverse effect of neoadjuvant chemotherapy was thrombocytopenia (3.4%). There were no severe adverse clinical symptoms. Consequently, R0 resection was achieved in 51 (98.1%) of 52 patients. Pathologic complete response occurred in 10 patients (19.2%). LIMITATIONS This was a single-arm, nonrandomized phase II study. CONCLUSIONS The combination of S-1 and oxaliplatin neoadjuvant chemotherapy and total mesorectal excision is a feasible and promising treatment option for resectable locally advanced rectal cancer. See Video Abstract at http://links.lww.com/DCR/B555. UN ESTUDIO PROSPECTIVO MULTICNTRICO FASE II SOBRE LA FACTIBILIDAD Y EFICACIA DE LA QUIMIOTERAPIA NEOADYUVANTE SCON OXALIPLATINO PARA EL CNCER DE RECTO LOCALMENTE AVANZADO ANTECEDENTES:La quimiorradioterapia neoadyuvante y la escisión mesorrectal total constituyen el estándar de atención para el cáncer de recto en varias guías. Sin embargo, la quimiorradioterapia neoadyuvante no ha mostrado beneficios claros en la sobrevida, pero si ha creado un aumento de eventos adversos. Por otro lado, se espera que la quimioterapia neoadyuvante prevenga los eventos adversos asociados a la radiación, aunque este tratamiento sigue siendo controvertido.OBJETIVO:Evaluar la factibilidad y eficacia de la quimioterapia neoadyuvante S-1 con oxaliplatino en conjunto con la escisión mesorrectal total para el cáncer de recto localmente avanzado resecable.DISEÑO:El estudio fue un ensayo prospectivo fase II de brazo único.AMBITO:Estudio realizado en múltiples instituciones.PACIENTES:Se incluyeron 58 pacientes con cáncer de recto localmente avanzado resecable.INTERVENCIÓN:Se administraron tres ciclos de S-1 con oxaliplatino antes de la cirugía. Se administró S-1 por vía oral a 80 mg / m2 / día durante 14 días consecutivos, seguido de un período de descanso de 7 días. El oxaliplatino se administró por vía intravenosa el primer día a una dosis de 130 mg / m2 / día. Se consideró la duración de un ciclo de 21 días. Posterior a la quimioterapia neoadyuvante se realizó la excisión total mesorrectal con disección ganglionar bilateral.PRINCIPALES VARIABLES EVALUDADAS:El estudio fue diseñado para conocer la factibilidad y eficacia de S-1 con oxaliplatino como quimioterapia neoadyuvante.RESULTADOS:La tasa de conclusión con tres ciclos de S-1 con oxaliplatino como quimioterapia neoadyuvante fue del 94,8% (55/58). Los motivos de interrupción fueron trombocitopenia (3,4%) y daño hepático (1,7%). El efecto adverso grave más común (grado ≥ 3) de la quimioterapia neoadyuvante fue la trombocitopenia (3,4%). No hubo síntomas clínicos adversos graves. Como resultado, la resección R0 se logró en 51 de 52 pacientes (98,1%). Una respuesta patológica completa se obtuvo en 10 pacientes (19,2%).LIMITACIONES:Fue un estudio de fase II no aleatorizado de un solo brazo.CONCLUSIONES:La combinación de S-1 con oxaliplatino como quimioterapia neoadyuvante y escisión mesorrectal total es factible y es una opción de tratamiento prometedora para el cáncer de recto localmente avanzado resecable. Consulte Video Resumen en http://links.lww.com/DCR/B555. (Traducción-Dr Juan Antonio Villanueva-Herrero).
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Affiliation(s)
- Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | | | | | | | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan
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12
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Stal J, Yi SY, Cohen-Cutler S, Gallagher P, Barzi A, Freyer DR, Milam JE, Lenz HJ, Miller KA. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist 2022; 27:579-586. [PMID: 35427410 PMCID: PMC9255970 DOI: 10.1093/oncolo/oyac052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Young adults (YA) diagnosed with rectal cancer are disproportionately impacted by the gonadotoxic effects of treatment and potential subsequent infertility. OBJECTIVE The purpose of this study was to characterize the prevalence of fertility preservation measures used, reasons why such measures were not used, and correlates of discussion between providers and YA rectal cancer survivors. DESIGN An online, cross-sectional survey was administered on the Facebook page of a national colorectal cancer (CRC) advocacy organization. Eligible participants were rectal cancer survivors diagnosed before age 50, between 6 and 36 months from diagnosis or relapse, and based in the US. RESULTS Participants were 148 rectal cancer survivors. Over half of the survivors reported that their doctor did not talk to them about potential therapy-related fertility complications. Only one-fifth of survivors banked sperm (males) or eggs/embryos (females) prior to their cancer therapy. Older age at diagnosis and greater quality of life were significantly associated with a higher likelihood of fertility discussions among males. Greater quality of life was significantly associated with a higher likelihood of fertility discussion among females. CONCLUSIONS These findings indicate that the majority of YA rectal cancer survivors do not receive, or cannot recall, comprehensive cancer care, and help to identify patients with rectal cancer who may be at risk for inadequate fertility counseling. Clinicians should provide proper counseling to mitigate this late effect and to ensure optimal quality of life for YA rectal cancer survivors.
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Affiliation(s)
- Julia Stal
- Corresponding author: Julia Stal, Department of Population and Public Health Sciences, Keck School of Medicine of USC, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA 90032, USA. Tel: +1 858 997 4071;
| | - Serena Y Yi
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Afsaneh Barzi
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - David R Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA,Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA,Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA,University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Joel E Milam
- School of Medicine, Department of Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Heinz-Josef Lenz
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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13
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Holowatyj AN, Eng C, Lewis MA. Incorporating Reproductive Health in the Clinical Management of Early-Onset Colorectal Cancer. JCO Oncol Pract 2022; 18:169-172. [PMID: 34554830 PMCID: PMC8932489 DOI: 10.1200/op.21.00525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Andreana N. Holowatyj
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,Vanderbilt-Ingram Cancer Center, Nashville, TN,Andreana N. Holowatyj, PhD, MSCI, Vanderbilt University Medical Center, 2525 West End Ave, Suite 334-G, Nashville, TN 37203; e-mail:
| | - Cathy Eng
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,Vanderbilt-Ingram Cancer Center, Nashville, TN
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14
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Sexual and urinary dysfunction after proctectomy with or without abdominoperineal resection: Incidence and treatment. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Akram W, Mitsakos AT. Colorectal Pathology in the Pelvis. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Warqaa Akram
- Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, East Carolina University. Greenville, North Carolina, USA
| | - Anastasios T. Mitsakos
- Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, East Carolina University. Greenville, North Carolina, USA
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Abstract
The complications encountered in colorectal surgery can be categorized into early and late. The most consequential early complication is anastomotic leak, which can be managed with percutaneous drainage or reoperation, depending on the patient's clinical status. Other early complications include anastomotic bleeding, surgical site infection, ileus, postoperative urinary retention, and stoma-related complications. Most stoma-related complications can be managed without reoperation. Late complications, such as bowel dysfunction, sexual dysfunction, and anastomotic stricture, are usually managed expectantly and should be discussed in the preoperative setting. There is growing interest in prevention of postoperative outcomes with preoperative nutritional supplementation and prehabilitation.
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17
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Perry WRG, Abd El Aziz MA, Duchalais E, Grass F, Behm KT, Mathis KL, Kelley SR. Sexual dysfunction following surgery for rectal cancer: a single-institution experience. Updates Surg 2021; 73:2155-2159. [PMID: 34236596 DOI: 10.1007/s13304-021-01124-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
Although much focus is placed on oncological outcomes for rectal cancer, it is important to assess quality of life after surgery of which sexual function is an important component. This study set about to describe the prevalence of sexual dysfunction by resection type and gender among patients undergoing surgery for rectal cancer, usingretrospective analysis. All English-speaking living patients who underwent surgery for stage I-III rectal cancer with curative intent between 2012 and 2016 were identified from a prospectively maintained database at our institution. Eligible patients were invited to complete either the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF). Primary outcomes were overall rates of sexual dysfunction, defined as more than one standard deviation below the mean of the normal population for each tool. A total of 147 patients responded, yielding a response rate of 38%. The overall sexual dysfunction rate was 70% at a median time from surgery of 38 months. Sixty-two men (62%) and 41 women (87%) reported overall scores that fell below one standard deviation of the population mean. There was no significant difference in sexual dysfunction for both male and female patients between low anterior resection, coloanal anastomosis, or abdominoperineal resection.. The present study revealed a high rate of sexual dysfunction after rectal cancer surgery, particularly in female patients. This study serves as a reminder to surgeons and their teams to openly discuss the impact of surgery on sexual function and ensure adequate consent and appropriate peri-operative management strategies. The retrospective nature of the analysis is the limitation of this study.
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Affiliation(s)
- William R G Perry
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA
| | - Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA.,Internal Medicine Department, Texas Tech University HSC El Paso/The Hospitals of Providence Transmountain Campus, 2000B Transmountain Road, Suite 400
- MSC 42001, El Paso, TX, 79911, USA
| | - Emilie Duchalais
- Digestive and Endocrine Surgery Clinic (CCDE), Institute of Diseases of the Digestive System (IMAD), University Hospital Center of Nantes, 1, Place Alexis-Ricordeau, 44093, Nantes, France
| | - Fabian Grass
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA.,Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA.
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18
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Morohashi H, Sakamoto Y, Miura T, Ichinohe D, Umemura K, Akaishi T, Sato K, Kuwata D, Yamazaki K, Wakiya T, Hakamada K. Effective dissection for rectal cancer with lateral lymph node metastasis based on prognostic factors and recurrence type. Int J Colorectal Dis 2021; 36:1251-1261. [PMID: 33527145 PMCID: PMC8119260 DOI: 10.1007/s00384-021-03870-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE There are no reports showing the significance and effective range of dissection for patients with lateral lymph node metastasis (LLNM). This study aimed to investigate the indications for lateral lymph node dissection (LLND) in patients with LLNM based on prognostic factors and recurrence types. METHODS We reviewed 379 patients with advanced rectal cancer who were treated with total mesorectal excision plus LLND. We analyzed background factors and survival times of patients who had LLNM to determine prognostic factors and recurrence types. RESULTS Pathological LLNM occurred in 44 (11.6%). Among patients with LLNM, the predictors of poor prognoses, according to univariate analysis, were > 3 node metastases, the presence of node metastasis on both sides, and spreading beyond the internal iliac lymph nodes. Moreover, LLNM beyond the internal iliac region was found to be an independent prognostic risk factor. Twenty-eight of the 44 patients with lateral lymph node metastasis (64%) relapsed, 22 of whom had distant metastases and 11 of whom experienced local recurrences. Among the latter group, nine (20%) and two (5%) had recurrences in the central and lateral pelvis, respectively. CONCLUSION The therapeutic benefit of resection was high, especially in patients with ≤ 3 positive lateral lymph nodes, one-sided bilateral lymph node areas, and positive nodes localized near the internal iliac artery.
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Affiliation(s)
- Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan.
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Daichi Ichinohe
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Kotaro Umemura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Takanobu Akaishi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Kentaro Sato
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Daisuke Kuwata
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Keisuke Yamazaki
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki-shi, 036-8562, Japan
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19
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Torrijo I, Balciscueta Z, Tabet J, Martín MC, López M, Uribe N. Prospective study of sexual function and analysis of risk factors after rectal cancer surgery. Colorectal Dis 2021; 23:1379-1392. [PMID: 33599035 DOI: 10.1111/codi.15589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/20/2022]
Abstract
AIM The aim of this study was to assess the evolution of sexual function over time after rectal cancer surgery and to identify risk factors that may have an impact on the deterioration of postoperative function. METHOD This was a prospective cohort study of sexual function after rectal cancer surgery using the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) preoperatively and at 6 and 12 months after surgery. Predictive factors of worsening were identified by univariate and multivariate analysis. RESULTS One hundred and one patients were included (56 men and 45 women). In men, the average IIEF showed decreased erectile function and intercourse satisfaction at 6 months (respectively 21.58 ± 7.18 to 16.60 ± 7.96, p = 0.002 and 10.87 ± 2.94, to 8.09 ± 4.45, p = 0.002) with recovery at 1 year. As a percentage, erectile dysfunction increased from the preoperative value to 6 months (64.5% vs 87.1%, p = 0.022) and was observed in 72% at 1 year. Patients with moderate to severe dysfunction increased from 22% preoperatively to 58% (p = 0.009) at 6 months and 44% at 1 year (p < 0.0001). Neoadjuvant chemoradiotherapy (OR 5.4, 95% CI 0.9-29.6; p = 0.041) and erectile worsening at 6 months (OR 20, 95% CI 1.6-238; p = 0.004) were independent factors for worse function at 6 or 12 months, respectively. No significant worsening of the FSFI was found, although there was an improvement in lubrication and orgasm. CONCLUSION Temporary deterioration of erectile function in men is common at 6 months after surgery and chemoradiotherapy is the only predictive factor. Furthermore, patients who remain dysfunctional show an increase in the severity of symptoms in relation to the preoperative period.
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Affiliation(s)
- Inmaculada Torrijo
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Zutoia Balciscueta
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Janine Tabet
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - M Carmen Martín
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Manuel López
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Natalia Uribe
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
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20
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Torrijo I, Balciscueta Z, Tabet J, Martín MC, López M, Uribe N. Prospective study of urinary function and analysis of risk factors after rectal cancer surgery. Tech Coloproctol 2021; 25:727-737. [PMID: 33811298 DOI: 10.1007/s10151-021-02445-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Alterations in urinary function are complications of rectal cancer surgery. The aim of this study was to prospectively analyze the changes in urinary function in patients operated on for rectal cancer, and to identify risk factors that may have an impact on the deterioration of postoperative urinary function. METHODS A prospective study of urinary function in rectal cancer patients who had elective oncological resection with curative intention at the Arnau de Vilanova Hospital in Valencia, Spain, from January 2017 to March 2019. The evaluation of urinary function was performed using the International Prostate Symptom Score (IPSS) preoperatively, at 6 and 12 months after surgery. Predictive factors of urinary dysfunction were identified by univariate and multivariate analysis. RESULTS Ninety-four patients were enrolled in the study. Eighty-seven of them completed all the follow-up assessments (48 men and 39 women, mean age 65.74 ± 10.95 years,). The mean IPSS was 7.96 ± 7.59 preoperatively, 9.01 ± 6.81 at 6 months, and 8.63 ± 5.59 at 12 months, without statistically significant differences. There were no differences in IPSS between males and females. Preoperative urinary dysfunction was 39% and at 12 months, a deterioration occurred in 23 patients (26.4%). IPSS analysis of symptoms showed a statistically significant worsening of nocturia at 6 months (p = 0.002) and 1 year after surgery (p = 0.037) in women. American Society of Anesthesiologists (ASA) class (OR: 11, [95% CI2.4-53]; p = 0.010), surgical difficulty (OR: 4.5, [95% CI 1-19]; p = 0.027) and anastomotic leakage (OR: 14, [95% CI 1.6-117]; p = 0.010), were identified as independent risk factors for deterioration of urinary function after surgery. CONCLUSIONS Our study showed worsening urinary dysfunction after rectal cancer surgery in 26.4% of the patients. However, there were no statistically significant differences in mean IPSS scores at the three assessment times (preoperatively, 6 months, 12 months). ASA class, surgical difficulty, and anastomotic leakage may predict postoperative deterioration.
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Affiliation(s)
- I Torrijo
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain.
| | - Z Balciscueta
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - J Tabet
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M C Martín
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M López
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - N Uribe
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
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21
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Risk factors for sexual dysfunction after rectal cancer surgery in 948 consecutive patients: A prospective cohort study. Eur J Surg Oncol 2021; 47:2087-2092. [PMID: 33832775 DOI: 10.1016/j.ejso.2021.03.251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sexual dysfunctions seriously affect the quality of life of patients. The aim of this study was to identify the risk factors for sexual dysfunction after rectal cancer surgery. METHODS A total of 948 consecutive patients undergoing rectal cancer radical resection were included between January 2012 and August 2019. The sexual functions were evaluated by the 5-item version of the International Index of Erectile Function (IIEF-5) in men and Index of Female Sexual Function (IFSF) in women at 12 months postoperatively. RESULTS Postoperative sexual dysfunction was observed in 228 patients with rectal cancer (24.05%), which included 150 cases in male patients (25.0%) and 78 cases in female patients (22.5%). A multivariate logistic regression analysis results showed that age ≥45 years old (OR = 1.72, p = 0.001), tumor below the peritoneal reflection (OR = 1.64, p = 0.005), receiving preoperative radiotherapy (OR = 4.12, p < 0.001) and undergoing abdominoperineal resection (APR), intersphincteric resection (ISR) and Hartmann surgery (OR = 2.43, p < 0.001) were the independent risk factors of sexual dysfunction for patients with rectal cancer. CONCLUSION Age ≥45 years old, tumors below the peritoneal reflection, receiving preoperative radiotherapy, and undergoing APR, ISR and Hartmann surgery were the independent risk factors of sexual dysfunction. Patients should be informed about the sexual dysfunctions in the pre-operative consultations. More attention should be paid to intraoperative pelvic autonomic nerve preservation on rectal cancer patients with these risk factors for clinic surgeons.
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22
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Sinimäki S, Elfeki H, Kristensen MH, Laurberg S, Emmertsen KJ. Urinary dysfunction after colorectal cancer treatment and its impact on quality of life - a national cross-sectional study in women. Colorectal Dis 2021; 23:384-393. [PMID: 33481335 DOI: 10.1111/codi.15541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/01/2021] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to investigate urinary dysfunction and its impact on the quality of life of colorectal cancer survivors. We also wanted to identify the risk factors for impaired urinary function. METHOD A national cross-sectional study was performed including patients treated for colorectal cancer between 2001 and 2014. Patients answered questionnaires regarding urinary function and quality of life, including the International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), measuring filling, voiding and incontinence. Data were compared with data on demographics and treatment-related factors from the Danish Colorectal Cancer Group (DCCG) database. RESULTS We found that rectal cancer treatment significantly impaired urinary function compared with colon cancer treatment (filling score p = 0.003, voiding p < 0.0001, incontinence p = 0.0001). Radiotherapy was the single most influential risk factor for high filling (p = 0.0043), voiding (p < 0.0001) and incontinence (p < 0.0001) scores, whereas type of rectal resection was only significant in crude analysis. Urinary dysfunction was strongly associated with an impaired quality of life. CONCLUSION Urinary dysfunction is common after treatment for colorectal cancer, particularly if the treatment includes radiotherapy. All patients must be informed of the risk before cancer treatment, and functional outcome should be routinely assessed at follow-up.
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Affiliation(s)
- Saija Sinimäki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Hossam Elfeki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine J Emmertsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Surgical Department, Regional Hospital Randers, Randers, Denmark
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23
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Thyø A, Laurberg S, Emmertsen KJ. Impact of bowel and stoma dysfunction on female sexuality after treatment for rectal cancer. Colorectal Dis 2020; 22:894-905. [PMID: 31985130 DOI: 10.1111/codi.14987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/14/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to measure the impact of bowel dysfunction and a poorly functioning stoma on the risk of sexual inactivity and sexual dysfunction in female patients. METHOD In a population-based cross-sectional study, Danish rectal cancer patients diagnosed between 2001 and 2014 were invited to answer a comprehensive questionnaire regarding cancer- and treatment-related late side effects after rectal cancer treatment. Bowel function was assessed using the Low Anterior Resection score and stoma function using the Colostomy Impact score. Female sexuality was measured by sexual activity, overall sexual dysfunction (the Rectal Cancer Female Sexuality score) and by different domains of sexual dysfunction (Sexual Vaginal Changes questionnaire). RESULTS Eight-hundred and thirteen female patients completed the questionnaire (response rate 49.2%). Major bowel dysfunction did not significantly increase the risk of sexual inactivity (OR 1.39, 95% CI 0.93-2.07) but clearly increased the risk of sexual dysfunction (OR 3.03, 95% CI 1.67-5.51). The most distinct problems were dyspareunia and inability to complete intercourse. On the contrary, poor stoma function increased the risk sexual inactivity (OR 2.26, 95% CI 1.16-4.40) but not the risk of sexual dysfunction (OR 0.74, 95% CI 0.27-1.99). The most distinct problem was dissatisfaction with own physical appearance. CONCLUSIONS Both bowel dysfunction and stoma dysfunction negatively, but differently, affect sexuality. After restorative surgery, bowel dysfunction was primarily associated with sexual dysfunction while poor stoma function after abdominoperineal excision was associated with sexual inactivity.
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Affiliation(s)
- A Thyø
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - K J Emmertsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Randers Regional Hospital, Randers, Denmark
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24
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Sörensson M, Asplund D, Matthiessen P, Rosenberg J, Hallgren T, Rosander C, González E, Bock D, Angenete E. Self-reported sexual dysfunction in patients with rectal cancer. Colorectal Dis 2020; 22:500-512. [PMID: 31713295 PMCID: PMC7317395 DOI: 10.1111/codi.14907] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/21/2019] [Indexed: 01/04/2023]
Abstract
AIM Patients with rectal cancer often experience sexual dysfunction after treatment. The aim of this study was to evaluate sexual function in a prospective cohort of patients regardless of treatment and tumour stage and explore what factors might affect sexual activity 1 year after diagnosis. METHOD The QoLiRECT study (Quality of Life in RECTal cancer) is a prospective study on the health-related quality of life in patients with rectal cancer in Denmark and Sweden. Questionnaires were completed at diagnosis and 1 year. Clinical data were retrieved from national quality registries. RESULTS Questionnaire data were available from 1085 patients at diagnosis and 920 patients at 1 year. Median age was 69 years (range 25-100). At diagnosis, 29% of the women and 41% of the men were sexually active, which was lower than an age-matched reference population. This was further reduced to 25% and 34% at 1 year. Risk factors for sexual inactivity were absence of sexual activity prior to the diagnosis and the presence of a stoma. Women experienced reduced lubrication and more dyspareunia at 1 year compared with the time of diagnosis. In men, erectile dysfunction increased from 46% to 55% at 1 year. CONCLUSION Sexual activity in patients with rectal cancer is lower at diagnosis compared with the population norm and is further reduced at 1 year. The presence of a stoma contributed to reduced sexual activity after operation. Sexual dysfunction was difficult to evaluate due to low sexual activity in the cohort. In men, erectile dysfunction is common.
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Affiliation(s)
- M. Sörensson
- Department of SurgeryKarlstad HospitalKarlstadSweden
| | - D. Asplund
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - P. Matthiessen
- Department of SurgeryFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - J. Rosenberg
- Department of SurgeryHerlev HospitalUniversity of CopenhagenHerlevDenmark
| | - T. Hallgren
- Department of SurgeryKarlstad HospitalKarlstadSweden
| | - C. Rosander
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - E. González
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - D. Bock
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - E. Angenete
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
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25
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Robotic-assisted surgery may be a useful approach to protect urinary function in the modern era of diverse surgical approaches for rectal cancer. Surg Endosc 2020; 35:1317-1323. [DOI: 10.1007/s00464-020-07509-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/14/2020] [Indexed: 01/27/2023]
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26
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Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal Cancer in the Young: Epidemiology, Prevention, Management. Am Soc Clin Oncol Educ Book 2020; 40:1-14. [PMID: 32315236 DOI: 10.1200/edbk_279901] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.
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Affiliation(s)
| | | | | | | | - Nilofer S Azad
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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27
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Fernández-Martínez D, Rodríguez-Infante A, Otero-Díez JL, Baldonedo-Cernuda RF, Mosteiro-Díaz MP, García-Flórez LJ. Is my life going to change?-a review of quality of life after rectal resection. J Gastrointest Oncol 2020; 11:91-101. [PMID: 32175110 DOI: 10.21037/jgo.2019.10.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Rectal resection is a common practice for colorectal surgeons. The causes of this procedure are varied. The most frequent is cancer, but also inflammatory bowel disease, endometriosis, and rectovaginal or rectourethral fistulas. The loss of the normal rectal reservoir function, urinary problems, sexual dysfunction or pelvic pain are frequently reported in patients after rectal surgery and these disorders markedly affect the overall quality of life (QoL). In the last decades, rectal surgery has radically changed, with the development of surgical techniques, and it has progressed from abdominoperineal resection (APR) with a permanent colostomy to sphincter-saving procedures. Nowadays, the use of sphincter-preserving surgery has increased, but all these surgical techniques can have important sequels that modify the QoL of the patients. Historically, surgical outcomes, such as complications, survival and recurrences, have been widely studied by surgeons. In the present day, surgical outcomes have improved, rectal cancer recurrence rate has decreased and survival has increased. For these reasons, it has begun to gain importance in aspects of the QoL of patients, such as body image, fecal continence and sexuality or urinary function. Therefore, physicians should know the influence of different techniques and approaches on functional outcomes and QoL, to be able to inform patients of the treatment benefits and risk of postoperative dysfunctions. The aim of our study is to review the current literature to determine to what degree the QoL of patients who underwent a rectal resection decreases, which domains are the most affected and, in addition, to establish the influence of different surgical techniques and approaches on functional outcomes.
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Affiliation(s)
- Daniel Fernández-Martínez
- Coloproctology Section, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - Jorge Luis Otero-Díez
- Coloproctology Section, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Ricardo Felipe Baldonedo-Cernuda
- Coloproctology Section, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - Luis Joaquin García-Flórez
- Coloproctology Section, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
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Karlsson L, Bock D, Asplund D, Ohlsson B, Rosenberg J, Angenete E. Urinary dysfunction in patients with rectal cancer: a prospective cohort study. Colorectal Dis 2020; 22:18-28. [PMID: 31334903 PMCID: PMC6973078 DOI: 10.1111/codi.14784] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
Abstract
AIM Urinary dysfunction is one of many complications after treatment for rectal cancer. The aim of this study was to evaluate the prevalence of patient-reported urinary dysfunction at the time of diagnosis and at 1-year follow-up and to assess the risk factors linked to urinary incontinence. METHOD Patients with newly diagnosed rectal cancer were included in the QoLiRECT study between 2012 and 2015. Questionnaires from the time of diagnosis and 1-year follow-up were analysed, with 1085 and 916 patients, respectively, eligible for analysis. Regression analyses were made to investigate possible risk factors for incontinence. The patient cohort was also compared with a cohort from the Swedish general population. RESULTS At baseline, the prevalence of urinary dysfunction (14% of women, 8% of men) was similar to that in the general population. At 1-year follow-up, 20% of patients experienced urinary incontinence (29% of women, 14% of men). Emptying difficulties were experienced by 46% (41% of women, 49% of men) and urgency by 58% across both sexes. Abdominoperineal excision and urinary dysfunction at baseline were found to be independent risk factors for incontinence at 1-year follow-up. Among patients who were continent at baseline, risk factors were female sex, physical inactivity at baseline, comorbidity and abdominoperineal excision. CONCLUSION Urinary dysfunction is frequent among patients with rectal cancer, with up to a two-fold increase in symptoms 1 year after diagnosis. Unfortunately, few factors are modifiable and these results stress the importance of informing patients of possible outcomes related to urinary dysfunction after treatment for rectal cancer.
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Affiliation(s)
- L. Karlsson
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - D. Bock
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - D. Asplund
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden,Region Västra GötalandSahlgrenska University Hospital/ÖstraDepartment of SurgeryGothenburgSweden
| | - B. Ohlsson
- Department of SurgeryBlekinge HospitalKarlshamnSweden
| | - J. Rosenberg
- Department of SurgeryHerlev HospitalUniversity of CopenhagenHerlevDenmark
| | - E. Angenete
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden,Region Västra GötalandSahlgrenska University Hospital/ÖstraDepartment of SurgeryGothenburgSweden
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Svanström Röjvall A, Buchli C, Bottai M, Ahlberg M, Flöter-Rådestad A, Martling A, Segelman J. Effect of radiotherapy for rectal cancer on female sexual function: a prospective cohort study. Br J Surg 2019; 107:525-536. [DOI: 10.1002/bjs.11373] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/15/2019] [Accepted: 08/25/2019] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Clinical experience and limited data show that female sexual function is influenced negatively by preoperative radiotherapy (RT) for rectal cancer. The aim of this prospective study was to investigate the impact of RT on sexual function and ovarian reserve measured by levels of anti-Müllerian hormone (AMH).
Methods
Women with stage I–III rectal cancer scheduled for surgery with or without preoperative (chemo)RT were included and followed for 2 years. Female Sexual Function Index (FSFI) questionnaire responses and blood samples for hormone analyses, including AMH in women aged 45 years or less, were collected at baseline and during follow-up.
Results
In the group of 109 women who received preoperative RT, median scores in all FSFI domains decreased over time, as did the total FSFI score (from 18·5 (range 2·0–36·0) at baseline to 10·8 (2·0–34·8) at 2 years; P < 0·001). In the group of 30 women who did not receive preoperative RT, only satisfaction declined over time (from 3·2 (0·8–6·0) to 1·8 (0·8–6·0); P = 0·012). In longitudinal regression analysis, the mean decline in FSFI total score was –9·33 (95 per cent c.i. –16·66 to –1·99; P = 0·013) for women who had preoperative RT compared with those who did not, with adjustment for age, Psychological General Well-being Index score and relationship with partner. A corresponding association was seen for arousal, lubrication, orgasm and pain. Five of six women aged 45 years or less with detectable serum levels of AMH at baseline had undetectable levels after RT.
Conclusion
Preoperative RT was associated with impairment in sexual function in women with rectal cancer. This needs to be considered when discussing choice of treatment and rehabilitation. In younger women, undetectable AMH levels after RT indicate an irreversible loss of ovarian follicles.
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Affiliation(s)
- A Svanström Röjvall
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Department of Surgery, St Göran's Hospital, Stockholm, Sweden
| | - C Buchli
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - M Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Stockholm, Sweden
| | - M Ahlberg
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - A Flöter-Rådestad
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Division of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - J Segelman
- Department of Molecular Medicine and Surgery, Institute of Environmental Medicine, Stockholm, Sweden
- Department of Surgery, Ersta Hospital, Stockholm, Sweden
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30
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Lee Y, McKechnie T, Springer JE, Doumouras AG, Hong D, Eskicioglu C. Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:2011-2021. [PMID: 31707560 DOI: 10.1007/s00384-019-03404-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Acute urinary retention (AUR) is a common postoperative complication in colorectal surgery. In pelvic colorectal operations, the optimal duration for postoperative urinary catheter use is controversial. This systematic review and meta-analysis aims to compare early (POD 1), intermediate (POD 3), and late (POD 5) urinary catheter removal. METHODS Medline, EMBASE, CENTRAL, and PubMed databases were searched. Articles were eligible for inclusion if they compared patients with urinary catheter removal on POD 1 or earlier to patients with urinary catheter removal on POD 2 or later in major pelvic colorectal surgeries. The primary outcome was rate of postoperative AUR. The secondary outcome was rates of postoperative urinary tract infection (UTI). RESULTS From 691 relevant citations, five studies with 928 patients were included. Comparison of urinary catheter removal on POD 1 versus POD 3 demonstrated no significant difference in rate of urinary retention (RR 1.36, 95%CI 0.83-2.21, P = 0.22); however, compared to POD 5, rates of AUR were significantly higher (RR 2.58, 95%CI 1.51-4.40, P = 0.0005). Rates of UTI were not significantly different between POD 1 and POD 3 urinary catheter removal (RR 0.40, 95%CI 0.05-3.71, P = 0.45), but removal on POD 5 significantly increased risk of UTI compared to POD 1 (RR 0.50, 95%CI 0.31-0.81, P = 0.005). CONCLUSION Risk of AUR can be minimized with late postoperative urinary catheter removal compared to early removal, but at the cost of increased risk of UTI. Patient-specific factors should be taken into consideration when deciding upon optimal duration of postoperative urinary catheterization.
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Affiliation(s)
- Yung Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeremy E Springer
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada.
- Division of General Surgery Department of Surgery, St. Joseph's Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
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Thyø A, Elfeki H, Laurberg S, Emmertsen KJ. Female sexual problems after treatment for colorectal cancer - a population-based study. Colorectal Dis 2019; 21:1130-1139. [PMID: 31095852 DOI: 10.1111/codi.14710] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/08/2019] [Indexed: 02/08/2023]
Abstract
AIM There has been limited focus on female sexuality after treatment for colorectal cancer. The aim of this study was to investigate long-term female sexual dysfunction in disease-free colorectal cancer survivors in the Danish population. METHOD All female Danish patients treated for colorectal cancer between 2001 and 2014 were included if they reported to have been sexually active at the time of diagnosis. They were requested to answer the validated Sexual Vaginal Changes Questionnaire. RESULTS A total of 2402 patients were included for analysis (43%). Overall, rectal cancer patients reported more sexual inactivity and problems compared to colon cancer patients, but there were no differences in any sexual function domains when excluding irradiated patients and patients with a permanent stoma. A permanent stoma was associated with sexual inactivity [OR 2.56 (95% CI 1.42-4.70)] and overall sexual dysfunction [OR 2.95 (95% CI 1.05-6.38)] in colon cancer patients, as well as inactivity [OR 1.43 (95% CI 1.01-2.04)] and overall dysfunction [OR 2.0 (95% CI 1.18-3.41)] in rectal cancer patients. Furthermore, a permanent stoma was associated with dyspareunia [OR 2.17 (95% CI 1.39-3.38)] and reduced vaginal dimension [OR 3.16 (95% CI 1.99-5.01)]. In rectal cancer patients, radiotherapy exposure increased the odds for overall sexual dysfunction [OR 1.80 (95% CI 1.02-3.16)] and was associated with dyspareunia [OR 1.72 (95% CI 0.95-3.12)]. CONCLUSION Sexual problems after treatment of colorectal cancer are common. Major risk factors are a permanent stoma and radiotherapy. Relevant patients should be offered professional counselling and treatment.
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Affiliation(s)
- A Thyø
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - H Elfeki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - K J Emmertsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Randers Regional Hospital, Randers, Denmark
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Quality of life in patients treated for anal carcinoma-a systematic literature review. Int J Colorectal Dis 2019; 34:1517-1528. [PMID: 31324957 DOI: 10.1007/s00384-019-03342-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Anal cancer is a mainly treated with chemoradiotherapy. A small number of patients undergo salvage surgery. There are few published studies investigating quality of life and functional outcome after treatment for anal cancer. The aim of this review was to explore the literature and identify areas for further research. METHODS A search was conducted in Medline using MESH terms related to anal cancer and quality of life. Two investigators selected and reviewed articles based on titles and abstracts. Three investigators read and reviewed the included articles and collected relevant data. The included articles were evaluated using the minimum standard checklist, and key findings were summarised in a chart. RESULTS Some 15 articles, and a total of 802 patients, were deemed eligible. The results differed slightly among the studies. The incidence of symptoms such as fatigue, nausea, insomnia and appetite loss was higher than among healthy volunteers. Bowel function, urinary function and sexual function were negatively affected. Some studies found that, compared with the normal population, anal cancer survivors scored clinically significant worse in the functional scales in QLQ-C30. CONCLUSION In conclusion, it is apparent that several functional problems affect the quality of life of patients with anal cancer. There are few studies which have investigated quality of life after treatment for anal cancer. Interventions to address issues related to anal cancer treatment may improve long-term quality of life in this patient group. TRIAL REGISTRATION CRD42017059787.
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Nevo A, Haidar AM, Navaratnam A, Humphreys M. Urinary Retention Following Non-urologic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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34
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A Review of Male and Female Sexual Function Following Colorectal Surgery. Sex Med Rev 2019; 7:422-429. [DOI: 10.1016/j.sxmr.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 12/21/2022]
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35
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The Effect of Major Pelvic Extirpative Surgery on Lower Urinary Tract Function. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Sexual Function in Patients with Stoma and its Consideration Among Their Caregivers: A Cross-Sectional Study. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Abdominoperineal Resection for Rectal Cancer in the Twenty-First Century: Indications, Techniques, and Outcomes. J Gastrointest Surg 2018; 22:1477-1487. [PMID: 29663303 DOI: 10.1007/s11605-018-3750-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of low rectal cancer continues to be a challenge, and decision making regarding the need for an abdominoperineal resection (APR) in patients with low-lying tumors is complicated. Furthermore, choices need to be made regarding need for modification of the surgical approach based on tumor anatomy and patient goals. DISCUSSION In this article, we address patient selection, preoperative planning, and intraoperative technique required to perform the three types of abdominoperineal resections for rectal cancer: extrasphincteric, extralevator, and intersphincteric. Attention is paid not only to traditional oncologic outcomes such as recurrence and survival but also to patient-reported outcomes and quality of life.
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Ledebo A, Bock D, Prytz M, Haglind E, Angenete E. Urogenital function 3 years after abdominoperineal excision for rectal cancer. Colorectal Dis 2018; 20:O123-O134. [PMID: 29679517 DOI: 10.1111/codi.14229] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/06/2018] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to explore urogenital dysfunction and associated risk factors after treatment of rectal cancer, in a large national cohort of patients 3 years after abdominoperineal excision, and to compare outcomes with a reference population and a cohort of patients operated for prostate cancer. METHOD Patients treated with abdominoperineal excision in 2007-2009 were identified using the Swedish Colorectal Cancer Registry. All consenting patients received a questionnaire. A sample of the Swedish population was contacted and completed a questionnaire. Patients undergoing radical prostatectomy in a prospective multicentre trial received questionnaires 24 months after surgery. RESULTS In the abdominoperineal excision, reference and radical prostatectomy populations 72%, 51% and 91% of the questionnaires were returned. Within the abdominoperineal excision group 36% of the men and 57% of the women were incontinent postoperatively. Fifteen per cent and 37% of men and women in the reference group were incontinent. Two years after radical prostatectomy 49% were incontinent. Seventy-four per cent of the men had erectile dysfunction after abdominoperineal excision. Nineteen per cent of the women experienced reduced ability to reach orgasm. Fewer men and women experienced their present sex life as satisfying after abdominoperineal excision for rectal cancer compared with the reference population. CONCLUSION A large proportion of patients endure persistent urogenital dysfunction after abdominoperineal excision for rectal cancer as do men after radical prostatectomy. Effects on sexual and urinary function should be part of preoperative information and after surgery patients should be asked about function in order to identify those in need of further assistance.
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Affiliation(s)
- A Ledebo
- Department of Surgery, NU Hospital Group, Trollhättan, Sweden
| | - D Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - M Prytz
- Department of Surgery, NU Hospital Group, Trollhättan, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - E Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - E Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Zhao Y, Hou XL, Ding JH, Zhao K, Xu X, Dong GL. Early Urinary Dysfunction after Laparoscopic Rectal Cancer Surgery: Does Surgeons’ Learning Curve Matter? Am Surg 2018. [DOI: 10.1177/000313481808400516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Poor early urinary outcomes after laparoscopy were reported in studies comparing laparoscopic versus open rectal cancer surgery. One possible explanation was that these studies might include a number of patients on the laparoscopic surgeons’ learning curve. This study aims to evaluate whether the learning curve of laparoscopic rectal cancer surgery influences early postoperative urinary dysfunction. Between September 2009 and December 2014, 208 consecutive patients undergoing laparoscopic rectal resection for rectal cancer were enrolled in the present study. All the clinical data were obtained from a prospectively compiled database. The primary outcomes were the incidences of postoperative urinary retention (POUR) and major urinary dysfunction requiring long-term urinary catheterization. POUR and major urinary dysfunction rate were 20.2 per cent (42/208) and 4.3 per cent (9/208), respectively. The learning curve analysis for operative time using the moving average method showed stabilization at 80 cases. Surgeon experience was divided into two periods: learning curve period (1–80 cases) and experienced period (81–208 cases). Multivariate analysis showed that older age (OR = 3.250, P = 0.006) and learning curve (OR = 2.241, P = 0.024) were independent risk factors for POUR. Learning curve was not significantly associated with increased rates of major urinary dysfunction (OR = 3.378, P = 0.092). Learning curve is a significant risk factor for increased rate of POUR after laparoscopic rectal cancer surgery. Technical training may be key to shorten the learning curve and limit its impact on the postoperative urinary complications.
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Affiliation(s)
- Yong Zhao
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Xiao-Ling Hou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Ke Zhao
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Xiao Xu
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Guang-Long Dong
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
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Risk Factor Analysis for Newly Developed Urogenital Dysfunction after Total Mesorectal Excision and Impact of Pelvic Intraoperative Neuromonitoring-a Prospective 2-Year Follow-Up Study. J Gastrointest Surg 2017; 21:1038-1047. [PMID: 28378317 DOI: 10.1007/s11605-017-3409-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/20/2017] [Indexed: 01/31/2023]
Abstract
AIM Urogenital dysfunction is a common sequela following total mesorectal excision for rectal cancer. This prospective study analyzed potential risk factors and investigated the impact of pelvic intraoperative neuromonitoring. METHOD Included were 85 patients undergoing total mesorectal excision for rectal cancer, 43 under the control of pelvic intraoperative neuromonitoring. Urogenital function was assessed with validated questionnaires within a 2-year follow-up period. Potential risk factors were identified by multivariate analysis. RESULTS Overall, approximately one-third of treated patients suffered from new onset of urinary dysfunction. Initially, half of the sexually active patients were affected by sexual dysfunction; after 2 years, almost three quarters were affected. In the pelvic intraoperative neuromonitoring group, urinary and sexual dysfunction rates including minor and major disturbances were significantly lower (2-year follow-up 20% vs. 51% (p = 0.004) and 56% vs. 90% (p = 0.010)). Throughout the survey, non-performance of pelvic intraoperative neuromonitoring was found to be an independent risk factor. Neoadjuvant chemoradiotherapy was identified as an independent predictor for urogenital dysfunction in the further course one and 2 years after surgery. CONCLUSION Pelvic intraoperative neuromonitoring is associated with significantly lower rates of urinary and sexual dysfunction in the short and long run, whereas neoadjuvant chemoradiotherapy has a negative impact only in the long run.
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Patrick Selph J, Saidian A. The Pharmacologic Management of Voiding Dysfunction, Stress Incontinence and the Overactive Bladder in Men and Women Who Have Had Prior Treatment for Pelvic Malignancies With Surgery or Radiation Therapy. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abdelli A, Tillou X, Alves A, Menahem B. Genito-urinary sequelae after carcinological rectal resection: What to tell patients in 2017. J Visc Surg 2017; 154:93-104. [PMID: 28161008 DOI: 10.1016/j.jviscsurg.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae. Identification of these nerves can be facilitated by intra-operative neuro-stimulation. In spite of these precautions, de novo urinary sequelae are observed in nearly 33% of patients and bladder evacuation disorders in 25% of patients. Advanced age, pre-operative urinary disorders, female gender, and abdomino-perineal resection are independent risk factors for urinary sequelae. Early post-operative urodynamic abnormalities might be predictive of these sequelae and justify early physiotherapy. Likewise, sexual sequelae such as erectile and/or ejaculatory disorders, dyspareunia and lubrication deficits result in de novo cessation of sexual activity in 28% of men and 18% of women. Advanced age, neo-adjuvant radiation therapy, and abdomino-perineal resection are independent risk factors for sexual dysfunction. Pharmacotherapy with sildenafil has proven useful in the treatment of erectile disorders. Genito-urinary and ano-rectal sequelae occur concomitantly in more than one of ten patients, suggesting a potential common pathophysiology.
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Affiliation(s)
- A Abdelli
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - X Tillou
- Service d'urologie et de transplantation rénale, CHU de Caen, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - A Alves
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - B Menahem
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France.
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Qiao Q, Che X, Li X, He S, Qiu G, Lu J, Wang J, Fan L. Recovery of Urinary Functions After Laparoscopic Total Mesorectal Excision for T4 Rectal Cancer. J Laparoendosc Adv Surg Tech A 2016; 26:614-7. [PMID: 27128311 DOI: 10.1089/lap.2015.0479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Qiao Qiao
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Xiangming Che
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Shicai He
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Guanglin Qiu
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Jing Lu
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Jin Wang
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Lin Fan
- Department of General Surgery, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, P.R. China
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Huyghe É, Almont T, Burte C, Marx E, Habold D, Bondil P. Formations en onco-sexologie : existant et perspectives. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-016-0568-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A prospective study of sexual and urinary function before and after total mesorectal excision. Int J Colorectal Dis 2016; 31:1125-30. [PMID: 26960814 DOI: 10.1007/s00384-016-2549-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncological treatment, research on rectal cancer survivors' urogenital function remains limited. In this study, urogenital dysfunction after surgical rectal cancer treatment was measured and possible predisposing factors that may have an impact on the development of this disorder were discussed. METHODS One hundred eight patients undergoing curative rectal cancer surgery from January 2008 to December 2014 were questioned using questionnaires: male urinary function was assessed using the International Prostatic Symptom Score (IPSS) questionnaire, for sexual function-International Index of Erectile Function (IIEF). The Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire and the Female Sexual Function Index (FSFI) were used for female urogenital function assessment prior to the operation and 6 months postoperatively. RESULTS A total of 67.0 % of male (36) and 33.0 % (18) of female patients who completed the questionnaire were included in the study. Preoperatively, male urinary dysfunction was 80.1 % and postoperatively-88.9 %. In female patients, preoperative urinary dysfunction was seen in 75.0 % patients, postoperatively-78.0 %. Erectile dysfunction was seen in 41.7 % males preoperatively and in 63.9 % postoperatively. A total of 83.3 % of female patients had sexual dysfunction preoperatively and 94 % postoperatively. CONCLUSION Sexual and urinary problems after surgery for rectal cancer are common. Preoperative genitourinary dysfunction is not uncommon in patients older than 60 years as well. Female patients reported higher rates of sexual dysfunction than males. These results point out the importance of sexual and urinary (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.
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Althumairi AA, Efron JE. Genitourinary Considerations in Reoperative and Complex Colorectal Surgery. Clin Colon Rectal Surg 2016; 29:145-51. [PMID: 27247540 PMCID: PMC4882184 DOI: 10.1055/s-0036-1580629] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Genitourinary structures are at risk of injury during colorectal surgery. The incidence of injury is low; however, the risk is higher in cases involving severe inflammatory or infectious processes, locally advanced or recurrent cancer, previous radiation, and reoperation. Consideration of the anatomical relationship between the genitourinary system, and the colon and rectum is crucial to avoid injuries. Intraoperative diagnostic techniques such as intravenous pyelogram (IVP), fluoroscopic cystogram, or retrograde urethrogram can aid in identifying suspected injuries. Early recognition and repair of injuries decrease the morbidity of an injury. Repair of injuries depends on the location and extent of the injury. Simple injuries may be repaired primarily, while complex injuries may require more advanced repairs such as a flap reconstruction.
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Affiliation(s)
- Azah A. Althumairi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan E. Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Gilmore B, Ezekian B, Sun Z, Peterson A, Mantyh C. Urinary Dysfunction in the Rectal Cancer Survivor. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bennett N, Incrocci L, Baldwin D, Hackett G, El-Zawahry A, Graziottin A, Lukasiewicz M, McVary K, Sato Y, Krychman M. Cancer, Benign Gynecology, and Sexual Function—Issues and Answers. J Sex Med 2016; 13:519-37. [DOI: 10.1016/j.jsxm.2016.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 12/20/2022]
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Riiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US, Forman A, Seyer-Hansen M. Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG 2016; 123:1360-7. [PMID: 26956803 DOI: 10.1111/1471-0528.13975] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis. DESIGN Prospectively collected data regarding the function of the pelvic organs. SETTING Tertiary endometriosis referral unit, Aarhus University Hospital. SAMPLE A cohort of 128 patients who underwent laparoscopic bowel resection for endometriosis. METHODS The International Consultation on Incontinence Questionnaire (ICIQ), Sexual Function-Vaginal Changes Questionnaire (SVQ), and the Low Anterior Resection Syndrome (LARS) questionnaire were answered before and after surgery. Non-invasive urodynamic testing was performed. MAIN OUTCOME MEASURES Pre- and postoperative function of the pelvic organs was compared, and risk factors for improved/impaired function were identified. RESULTS A total of 96.1% of the women completed the 1-year follow-up. A significant decrease (P = 0.002) in bladder filling problems (F-score) was observed 1 year after surgery, primarily caused by a significant decrease in bladder pain (P = 0.0001). No change for urodynamic parameters was observed. A significant increase in overall sexual satisfaction (P = 0.0001) and decrease in worries about sexual life (P = 0.001) was seen 1 year after surgery. Frequency of defecation was significantly increased 1 year after surgery (P = 0.0001), but the overall bowel function measured by LARS score was unchanged. Patients with anastomotic leakage had a significantly higher risk (odds ratio, OR 5.40; P = 0.002) of increased incontinence problems (I-score) 1 year after surgery. CONCLUSION A significant and clinically relevant improvement in urinary and sexual function 1 year after laparoscopic bowel resection for endometriosis was found. Except for anastomotic leakage, this could be observed independent of any patient- or treatment-related factor. Apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection in endometriosis patients. TWEETABLE ABSTRACT Rectal resection for endometriosis does not impair urinary and sexual function 1 year after surgery.
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Affiliation(s)
- M Riiskjaer
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - S Greisen
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - M Glavind-Kristensen
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - U S Kesmodel
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Copenhagen, Denmark
| | - A Forman
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - M Seyer-Hansen
- Deptartment of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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