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Du Q, Yang W, Zhang J, Qiu S, Liu X, Wang Y, Yang L, Zhou Z. Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis. Int J Surg 2024; 110:2338-2348. [PMID: 36928167 PMCID: PMC11020000 DOI: 10.1097/js9.0000000000000205] [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: 06/12/2022] [Accepted: 11/20/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND The efficacy of intersphincteric resection (ISR) surgery for patients with lower rectal cancer remains unclear compared to abdominoperineal resection (APR). The aim of this study is to compare the oncologic outcomes for lower rectal cancer patients after ISR and APR through a systematic review and meta-analysis. MATERIALS AND METHODS A systematic electronic search of the Cochrane Library, PubMed, EMBASE, and MEDLINE was performed through January 12, 2022. The primary outcomes included 5-year disease-free survival (5y-DFS) and 5-year overall survival. Secondary outcomes included circumferential resection margin involvement, local recurrence, perioperative outcomes, and other long-term outcomes. The pooled odds ratios, mean difference, or hazard ratios (HRs) of each outcome measurement and their 95% CIs were calculated. RESULTS A total of 20 nonrandomized controlled studies were included in the qualitative analysis, with 1217 patients who underwent ISR and 1135 patients who underwent APR. There was no significant difference in 5y-DFS (HR: 0.84, 95% CI: 0.55-1.29; P =0.43) and 5-year overall survival (HR: 0.93, 95% CI: 0.60-1.46; P =0.76) between the two groups. Using the results of five studies that reported matched T stage and tumor distance, we performed another pooled analysis. Compared to APR, the ISR group had equal 5y-DFS (HR: 0.76, 95% CI: 0.45-1.30; P =0.31) and 5y-LRFS (local recurrence-free survival) (HR: 0.72, 95% CI: 0.29-1.78; P =0.48). Meanwhile, ISR had equivalent local control as well as perioperative outcomes while significantly reducing the operative time (mean difference: -24.89, 95% CI: -45.21 to -4.57; P =0.02) compared to APR. CONCLUSIONS Our results show that the long-term survival and safety of patients is not affected by ISR surgery, although this result needs to be carefully considered and requires further study due to the risk of bias and limited data.
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Affiliation(s)
- Qiang Du
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Wenming Yang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Jianhao Zhang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Siyuan Qiu
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Xueting Liu
- Department of Evidence-Based Medicine and Clinical Epidemiology
| | - Yong Wang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Lie Yang
- Department of General Surgery, Division of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zongguang Zhou
- Department of General Surgery, Division of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Yang S, Lin Y, Zhong W, Xu W, Huang Z, Cai S, Chen W, Zhang B. Effect of laparoscopic versus open surgery on postoperative wound complications in patients with low rectal cancer: A meta-analysis. Int Wound J 2024; 21:e14471. [PMID: 37935425 PMCID: PMC10898391 DOI: 10.1111/iwj.14471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023] Open
Abstract
This meta-analysis was conducted to evaluate the effect of microinvasive and open operations on postoperative wound complications in low rectal carcinoma patients. Research on limited English has been conducted systematically in PubMed, Embase, Cochrane Library and Web of Science. The date up to the search was in August 2023. Following review of the classification and exclusion criteria for this research and the evaluation of its quality in the literature, there were a total of 266 related papers, which were reviewed for inclusion in the period from 2004 to 2017. A total of 1774 cases of low rectal cancer were enrolled. Of these 913 cases, the laparoscopic operation was performed on 913 cases, while 861 cases were operated on low rectal carcinoma. The overall sample was between 10 and 482. Five trials described the efficacy of laparoscopy have lower risk than open on postoperative wound infection in patients with low rectal cancer (OR, 0.72;95 % CI, 0.48,1.09 p = 0.12). Three studies results showed that the anastomotic leak was not significantly different between open and laparoscopy (OR, 0.86; 95% CI, 0.58,1.26 p = 0.44). Six surgical trials in low rectal cancer patients reported haemorrhage, and five cases of surgical time were reported, with laparoscopy having fewer bleeding compared with open surgery (MD, -188.89; 95% CI, -341.27, -36.51 p = 0.02). Compared with laparoscopy, the operation time was shorter for the open operation (MD, 33.06; 95% CI, 30.56, 35.57 p < 0.0001). Overall, there is no significant difference between laparoscopy and open surgery in terms of incidence of infection and anastomosis leak. However, the rate of haemorrhage in laparoscopy is lower,and operation time in open surgery is lower.
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Affiliation(s)
- Shu Yang
- Department of Traditional Chinese MedicineThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
| | - Yuting Lin
- Department of Traditional Chinese MedicineThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
| | - Wenjin Zhong
- Department of Clinical LaboratoryThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
| | - Wenji Xu
- Department of gastroenterologyThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
| | - Zhongxin Huang
- Department of PathologyThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
| | - Suqin Cai
- Department of PathologyThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
| | - Wen Chen
- Department of Traditional Chinese MedicineThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
| | - Baogen Zhang
- Department of Traditional Chinese MedicineThe second affiliated hospital of Fujian Medical UniversityQuanzhouChina
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Rooney MK, Pasli M, Chang GJ, Das P, Koay EJ, Koong AC, Ludmir EB, Minsky BD, Noticewala SS, Peacock O, Smith GL, Holliday EB. Patient-Reported Sexual Function, Bladder Function and Quality of Life for Patients with Low Rectal Cancers with or without a Permanent Ostomy. Cancers (Basel) 2023; 16:153. [PMID: 38201580 PMCID: PMC10778006 DOI: 10.3390/cancers16010153] [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: 11/23/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Despite the increasing utilization of sphincter and/or organ-preservation treatment strategies, many patients with low-lying rectal cancers require abdominoperineal resection (APR), leading to permanent ostomy. Here, we aimed to characterize overall, sexual-, and bladder-related patient-reported quality of life (QOL) for individuals with low rectal cancers. We additionally aimed to explore potential differences in patient-reported outcomes between patients with and without a permanent ostomy. METHODS We distributed a comprehensive survey consisting of various patient-reported outcome measures, including the FACT-G7 survey, ICIQ MLUTS/FLUTS, IIEF-5/FSFI, and a specific questionnaire for ostomy patients. Descriptive statistics and univariate comparisons were used to compared demographics, treatments, and QOL scores between patients with and without a permanent ostomy. RESULTS Of the 204 patients contacted, 124 (60.8%) returned completed surveys; 22 (18%) of these had a permanent ostomy at the time of survey completion. There were 25 patients with low rectal tumors (≤5 cm from the anal verge) who did not have an ostomy at the time of survey completion, of whom 13 (52%) were managed with a non-operative approach. FACTG7 scores were numerically lower (median 20.5 vs. 22, p = 0.12) for individuals with an ostomy. Sexual function measures IIEF and FSFI were also lower (worse) for individuals with ostomies, but the results were not significantly different. MLUTS and FLUTS scores were both higher in individuals with ostomies (median 11 vs. 5, p = 0.06 and median 17 vs. 5.5, p = 0.01, respectively), suggesting worse urinary function. Patient-reported ostomy-specific challenges included gastrointestinal concerns (e.g., gas, odor, diarrhea) that may affect social activities and personal relationships. CONCLUSIONS Despite a limited sample size, this study provides patient-centered, patient-derived data regarding long-term QOL in validated measures following treatment of low rectal cancers. Ostomies may have multidimensional negative impacts on QOL, and these findings warrant continued investigation in a prospective setting. These results may be used to inform shared decision making for individuals with low rectal cancers in both the settings of organ preservation and permanent ostomy.
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Affiliation(s)
- Michael K. Rooney
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Melisa Pasli
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - George J. Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Prajnan Das
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Eugene J. Koay
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Albert C. Koong
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Ethan B. Ludmir
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Bruce D. Minsky
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Sonal S. Noticewala
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Oliver Peacock
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Grace L. Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
| | - Emma B. Holliday
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (M.P.); (S.S.N.)
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Zhou YM, Zang YW, Li ZY, Zhou MW, Wang ZH, Chen ZY, Ding JH, Xiang JB. Conformal sphincteric resection for ultra-low rectal cancer located below the dentate line: A pilot report. Colorectal Dis 2023; 25:2414-2422. [PMID: 37908184 DOI: 10.1111/codi.16776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/15/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023]
Abstract
AIM Sphincter-sparing surgery can be achieved in most cases of low rectal cancer with the development of intersphincteric resection. However, abdominoperineal resection is still inevitable for patients with tumours located below the dentate line. To address this, we have developed a procedure called conformal sphincteric resection (CSR) in which the corresponding part of the subcutaneous portion of the external anal sphincter and the perianal skin on the tumour side is removed to achieve a safe distal resection margin and lateral resection margin while the dentate line and the internal anal sphincter on the tumour-free side are preserved as much as possible, to achieve sphincter preservation without compromising oncological safety and functional acceptability, and to render tumour location no longer a contraindication for sphincter-sparing surgery. This is the first study to describe the concept, indication and surgical procedure of CSR and to report its preliminary surgical, oncological and functional results. METHODS This is a retrospective, single-centre, single-arm pilot study conducted at Huashan Hospital, Fudan University. Demographic, clinicopathological, oncological and functional follow-up data were collected from 20 consecutive patients with rectal tumours located below the dentate line who underwent laparoscopic CSR by the same surgical team from June 2018 to March 2022. RESULTS The mean distance of the tumour's lower edge from the anal verge was 13.1 ± 6.0 mm. The mean distal resection margin was 10.6 ± 4.3 mm. All circumferential resection margins were negative. There were no instances of perioperative mortality. The complication rate was 25% but all were Clavien-Dindo Grade I. Among the 20 cases, 17 were diagnosed with adenocarcinoma, one with squamous cell carcinoma and two with adenoma featuring high-grade intraepithelial neoplasia. Pathological TNM staging revealed two, seven, five, five and one case(s) in Stages 0, I, II, III and IV, respectively. The median follow-up period was 20 months (interquartile range 22 months), with no withdrawals. The overall and disease-free survival rates were both 95%. The mean Wexner incontinence score and low anterior resection syndrome score recorded 18 months following diverting ileostomy closure were 6.3 ± 3.8 and 27.3 ± 3.6, respectively. CONCLUSIONS This study has proposed the CSR procedure for the first time, which is a technically feasible, oncologically safe and functionally acceptable procedure for carefully selected patients with rectal tumours located below the dentate line.
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Affiliation(s)
- Yi-Ming Zhou
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi-Wen Zang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen-Yang Li
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Min-Wei Zhou
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zi-Hao Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zong-You Chen
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, Characteristic Medical Centre of PLA Rocket Force, Beijing, China
| | - Jian-Bin Xiang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Shen Y, Yang T, Zeng H, Meng W, Deng X, Wei M, Wang Z. Low anterior resection syndrome and quality of life after intersphincteric resection for rectal cancer: a propensity score-matched study. Tech Coloproctol 2023; 27:1307-1317. [PMID: 37804461 DOI: 10.1007/s10151-023-02848-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Our aim was to perform a propensity score-matched study to compare the long-term functional outcomes and quality of life following intersphincteric resection vs. low anterior resection (LAR) with very low anastomosis. METHODS Patients who underwent intersphincteric resection or low anterior resection with low anastomosis (≤ 4 cm from the anal verge) for rectal cancer between January 2017 and June 2020 were retrospectively included. A propensity score-matching process was performed. Functional outcomes and quality of life were assessed using the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), EORC-QLQ C30, EORC-QLQ CR29, Low Anterior Resection Syndrome (LARS), Wexner, and International Prostate Symptom Score (IPSS) questionnaires. The primary outcome was the presence of LARS at least 12 months after surgery. The second outcome was the postoperative quality of life of included patients. RESULTS After propensity matching, 128 patients were included, including 58 males and 70 females with a median age of 59.5. Patients in the intersphincteric resection group showed a higher incidence of incontinence to flatus (32.8% versus 14.0%, p = 0.043) and stools (42.2% versus 21.9%, p = 0.046), pain/discomfort (25.0% versus 7.8%, p = 0.001), and bowel dysfunction, while the LARS scores (15.0 versus 13.2, p = 0.461) and major LARS rates (26.6% versus 14.1%, p = 0.078) were comparable in both groups. CONCLUSION ISR leads to increased bowel incontinence rate and increased anal pain, without affecting the grade of low anterior resection syndrome, fecal urgency, and clustering. LAR might be the preferred sphincteric-preserving approach when negative resection margins and a safe anastomosis are guaranteed. Patients should be fully informed about potential functional impairment after sphincter-preservation procedures.
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Affiliation(s)
- Y Shen
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - T Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - H Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - W Meng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - X Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
| | - M Wei
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
| | - Z Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
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Shukla S, Singh P, Shukla S, Ali S, Didwania N. Scope of Onsite, Portable Prevention Diagnostic Strategies for Alternaria Infections in Medicinal Plants. BIOSENSORS 2023; 13:701. [PMID: 37504100 PMCID: PMC10377195 DOI: 10.3390/bios13070701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023]
Abstract
Medicinal plants are constantly challenged by different biotic inconveniences, which not only cause yield and economic losses but also affect the quality of products derived from them. Among them, Alternaria pathogens are one of the harmful fungal pathogens in medicinal plants across the globe. Therefore, a fast and accurate detection method in the early stage is needed to avoid significant economic losses. Although traditional methods are available to detect Alternaria, they are more time-consuming and costly and need good expertise. Nevertheless, numerous biochemical- and molecular-based techniques are available for the detection of plant diseases, but their efficacy is constrained by differences in their accuracy, specificity, sensitivity, dependability, and speed in addition to being unsuitable for direct on-field studies. Considering the effect of Alternaria on medicinal plants, the development of novel and early detection measures is required to detect causal Alternaria species accurately, sensitively, and rapidly that can be further applied in fields to speed up the advancement process in detection strategies. In this regard, nanotechnology can be employed to develop portable biosensors suitable for early and correct pathogenic disease detection on the field. It also provides an efficient future scope to convert innovative nanoparticle-derived fabricated biomolecules and biosensor approaches in the diagnostics of disease-causing pathogens in important medicinal plants. In this review, we summarize the traditional methods, including immunological and molecular methods, utilized in plant-disease diagnostics. We also brief advanced automobile and efficient sensing technologies for diagnostics. Here we are proposing an idea with a focus on the development of electrochemical and/or colorimetric properties-based nano-biosensors that could be useful in the early detection of Alternaria and other plant pathogens in important medicinal plants. In addition, we discuss challenges faced during the fabrication of biosensors and new capabilities of the technology that provide information regarding disease management strategies.
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Affiliation(s)
- Sadhana Shukla
- Manav Rachna Centre for Medicinal Plant Pathology, Manav Rachna International Institute of Research and Studies, Faridabad 121004, India
- TERI-Deakin Nanobiotechnology Centre, The Energy and Resources Institute, Gurgaon 122003, India
| | - Pushplata Singh
- TERI-Deakin Nanobiotechnology Centre, The Energy and Resources Institute, Gurgaon 122003, India
| | - Shruti Shukla
- TERI-Deakin Nanobiotechnology Centre, The Energy and Resources Institute, Gurgaon 122003, India
| | - Sajad Ali
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Nidhi Didwania
- Manav Rachna Centre for Medicinal Plant Pathology, Manav Rachna International Institute of Research and Studies, Faridabad 121004, India
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Zhang B, Zhuo GZ, Zhao Y, Zhao YJ, Zhu J, Liu FF, Ding JH. Quality of Life and Functional Outcomes After Intersphincteric Resection for Ultralow Rectal Cancer: A Prospective Observational Study. Dis Colon Rectum 2023; 66:1029-1038. [PMID: 36602458 DOI: 10.1097/dcr.0000000000002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Intersphincteric resection is the ultimate sphincter-preserving surgical technique for ultralow rectal cancer, but quality-of-life changes after surgery remain unclear. It is also unknown which questionnaire has better associations with functional results for capturing clinical variation in quality of life. OBJECTIVE This study aimed to assess change in the quality of life and its correlation with functional outcomes among patients undergoing intersphincteric resection for ultralow rectal cancer. DESIGN This was a prospective, observational, single-center study. SETTINGS Colorectal surgery referral center. PATIENTS Patients with ultralow rectal cancer who underwent intersphincteric resection were included. MAIN OUTCOME MEASURES The primary outcomes were quality-of-life and functional results at 3 to 6, 12, and 24 months after ileostomy closure using validated questionnaires. The secondary outcome was the relationship between quality of life and neorectal function. RESULTS A total of 102 patients (62.7% men) completed follow-up surveys. Wexner incontinence score and Kirwan's incontinence score significantly improved at 12 months after ileostomy reversal, but such improvement in low anterior resection syndrome score was proved until 24 months later ( p = 0.01). Condition-specific quality-of-life domains improved over time, with significant changes in lifestyle ( p = 0.02) and coping/behavior ( p = 0.01), as well as the summary score of Fecal Incontinence Quality of Life ( p = 0.02) and visual analog scale score ( p < 0.001). Among health-related quality-of-life domains, the subscale scores did not differ significantly. The functional systems scores were significantly correlated with all the domains of condition-specific quality-of-life but only a few health-related quality-of-life domains. Only weak to moderate associations with the functional outcomes were observed for both quality-of-life questionnaires. LIMITATIONS Single-center data and limited sample size. CONCLUSIONS Although low anterior resection syndrome persists for years after intersphincteric resection, condition-specific quality of life and functional outcomes improve over time. Compared to health-related quality-of-life questionnaires, condition-specific quality-of-life instruments might be preferable to evaluate changes in quality-of-life after surgery. See Video Abstract at http://links.lww.com/DCR/C130 . CALIDAD DE VIDA Y RESULTADOS FUNCIONALES DESPUS DE UNA RESECCIN INTERESFINTRICA EN CASO DE CNCER RECTAL ULTRABAJO ESTUDIO PROSPECTIVO OBSERVACIONAL ANTECEDENTES:La resección inter-esfintérica es la última técnica quirúrgica conservadora de esfínteres en casos de cáncer rectal ultrabajo, pero los cambios en la calidad de vida después de la cirugía siguen sin estar claros. Se desconoce también, qué tipo de cuestionario tiene mejor asociación con los resultados funcionales para así captar las variaciones clínicas en la calidad de vida.OBJETIVO:Evaluar el cambio en la calidad de vida y su correlación con los resultados funcionales durante el período postoperatorio en pacientes sometidos a resección interesfintérica por cáncer de recto ultrabajo.DISEÑO:Estudio prospectivo, observacional y de un solo centro.AJUSTES:Centro de referencia de cirugía colorrectal.PACIENTES:Se incluyeron pacientes con cáncer de recto ultra bajo que se sometieron a resección interesfintérica con el cierre de la ileostomía.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la calidad de vida y los resultados funcionales a los 3-6, 12 y 24 meses después del cierre de la ileostomía utilizando cuestionarios validados. El resultado secundario fue la relación entre la calidad de vida y la función del néorecto.RESULTADOS:Un total de 102 pacientes (62,7% hombres) completaron las encuestas de seguimiento. La puntuación de incontinencia de Wexner y la puntuación de incontinencia de Kirwan mejoraron significativamente a los 12 meses después del cierre de la ileostomía, pero dicha mejoría en la puntuación del síndrome de resección anterior baja se demostró solo hasta 24 meses después ( p = 0,01). Las condiciones en el dominio de la calidad de vida específicos mejoraron con el tiempo, con cambios significativos en el estilo de vida ( p = 0,02) y el afrontamiento/comportamiento ( p = 0,01), así como la puntuación general de la calidad de vida y de la incontinencia fecal ( p = 0,02), puntuación de la escala analógica visual ( p < 0,001). Entre los dominios de la calidad de vida relacionada con la salud, las puntuaciones de las sub-escalas no difirieron significativamente. Las puntuaciones de los sistemas funcionales se correlacionaron significativamente con todos los dominios de la calidad de vida específica de la nueva condición, pero solo con pocos dominios de calidad de vida relacionados con la salud. Solo se observaron asociaciones débiles a moderadas con los resultados funcionales para ambos cuestionarios de calidad de vida.LIMITACIONES:Datos de un solo centro y tamaño de muestra limitado.CONCLUSIONES:Aunque el síndrome de resección anterior baja persiste durante años después de la resección interesfintérica, la calidad de vida específica de la nueva condición y los resultados funcionales mejoran con el tiempo. En comparación con los cuestionarios de calidad de vida relacionados con la salud, los instrumentos de calidad de vida específicos de la nueva condición pueden ser preferibles para evaluar los cambios en la calidad de vida después de la cirugía. Consulte Video Resumen en http://links.lww.com/DCR/C130 . (Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Bin Zhang
- Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, China
| | - Guang-Zuan Zhuo
- Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, China
| | - Yong Zhao
- Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, China
| | - Yu-Juan Zhao
- Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, China
- Postgraduate Training Base of Jinzhou Medical University, Characteristic Medical Center of PLA Rocket Force, Beijing, China
| | - Jun Zhu
- Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, China
| | - Fei-Fan Liu
- Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, China
- Postgraduate Training Base of Jinzhou Medical University, Characteristic Medical Center of PLA Rocket Force, Beijing, China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, China
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Sun G, Lou Z, Zheng K, Chen Y, Zhang H, Wen R, Gao X, Meng R, Gong H, Bai C, Furnée EJB, Zhang W. Comparison of functional and oncological outcome of conformal sphincter preservation operation, low anterior resection, and abdominoperineal resection in very low rectal cancer: a retrospective comparative cohort study with propensity score matching. Langenbecks Arch Surg 2023; 408:208. [PMID: 37222797 DOI: 10.1007/s00423-023-02925-1] [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: 07/30/2022] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Conformal sphincter preservation operation (CSPO) procedure is a sphincter preservation procedure for preserving the anal canal function for very low rectal cancers. This study investigated the functional and oncological outcome of conformal sphincter preservation operation by comparing with low anterior resection (LAR) and abdominoperineal resection (APR). METHODS This is a retrospective comparative study. Patients who received conformal sphincter preservation operation (n = 52), low anterior resection (n = 54), or abdominoperineal resection (n = 69) were included between 2011 and 2016 in a tertiary referral hospital. Propensity score matching was applied to adjust the baseline characteristics which may influence the choice of the surgical procedure. RESULTS Twenty-one pairs of conformal sphincter preservation operation vs. low anterior resection and 29 pairs of conformal sphincter preservation operation vs. abdominoperineal resection were selected. The first group had a higher tumor location than the second group. Compared with the low anterior resection group, the conformal sphincter preservation operation group had shorter distal resection margins; however, no significant differences were identified in daily stool frequency, Wexner incontinence score, local recurrence, distant metastasis, overall survival, and disease-free survival between both groups. Compared with the abdominoperineal resection group, the conformal sphincter preservation operation group had shorter operative time and shorter postoperative hospital stay. No significant differences were identified in local recurrence, distant metastasis, overall survival, and disease-free survival. CONCLUSION Conformal sphincter preservation operation is oncologically safe compared to APR and LAR, and has similar functional findings to LAR. Studies comparing CSPO with intersphincteric resection should be performed.
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Affiliation(s)
- Ge Sun
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Zheng Lou
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - Kuo Zheng
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - Yuntao Chen
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Hang Zhang
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - Rongbo Wen
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - Xianhua Gao
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - Ronggui Meng
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - Haifeng Gong
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - Chenguang Bai
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - Edgar J B Furnée
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China.
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9
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Mai-Phan TA, Pham VQ. Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire. Ann Coloproctol 2022:ac.2022.00514.0073. [PMID: 36426406 DOI: 10.3393/ac.2022.00514.0073] [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: 07/24/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study was to validate the low anterior resection syndrome (LARS) score questionnaire in the Vietnamese language among Vietnamese patients who underwent sphincter-preserving surgery for rectal cancer. Methods The LARS score questionnaire was translated from English into Vietnamese and then back-translated as recommended internationally. From January 2018 to December 2020, 93 patients who underwent sphincter-preserving surgery completed the Vietnamese version of the LARS score questionnaire together with an anchored question assessing the influence of bowel function on quality of life (QoL). To validate test-retest reliability, patients were requested to answer the LARS score questionnaire twice. Results Ninety-three patients completed the LARS score questionnaire, of whom 89 responded twice. The patients who responded twice were included in the analysis of test-retest reliability. Fifty-eight patients had a "major" LARS score. The LARS score was able to discriminate between patients who were obese and those who were not (P<0.001) and between the low anterior resection and anterior resection procedures (P<0.001). Age and sex were not associated with higher LARS scores (P=0.975). There was a perfect fit between the QoL category question and the LARS score in 56.2% of cases, and a moderate fit was found in 42.7% of cases, showing reasonable convergent validity. The test-retest reliability of 89 patients showed a high intraclass correlation coefficient. Conclusion The Vietnamese version of the LARS score questionnaire is a valid tool for measuring LARS.
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Affiliation(s)
- Tuong-Anh Mai-Phan
- Department of General Surgery, Nhan dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
- Department of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Vu Quang Pham
- Department of General Surgery, Nhan dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
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10
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The Quality of Life of Patients with Surgically Treated Colorectal Cancer: A Narrative Review. J Clin Med 2022; 11:jcm11206211. [PMID: 36294531 PMCID: PMC9604858 DOI: 10.3390/jcm11206211] [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: 10/04/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Quality of life is a topic increasingly being addressed by researchers. Due to the increasing incidence of colorectal cancer, this issue is particularly relevant. Despite the increasing number of publications on this topic each year, it still requires further research. The aim of this study was to analyze the available literature from the past 10 years, addressing the topic of QoL in patients with colorectal cancer which has been treated surgically. MATERIAL AND METHODS This review is based on 93 articles published between 2012 and 2022. It analyzes the impact of socioeconomic factors, the location and stage of the tumor, stoma and the method of surgical treatment on patients' QoL and sexual functioning. RESULTS CRC has a negative impact on patients' financial status, social functioning, pain and physical functioning. Patients with stage II or III cancer have an overall lower QoL than patients with stage I. The more proximally the lesion is located to the sphincters, the greater the negative impact on the QoL. There was a significant difference in favor of laparoscopic surgery compared with open surgery. In patients with a stoma, the QoL is lower compared with patients with preserved gastrointestinal tract continuity. The more time has passed since surgery, the more the presence of a stoma has a negative impact on QoL. Surgery for CRC negatively affects patients' sex lives, especially in younger people and among men. CONCLUSIONS This study may contribute to the identification of the factors that affect the QoL of patients with surgically treated colorectal cancer. This will allow even more effective and complete treatment, facilitating patients' return to normal physical, mental and social functioning.
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11
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Comparative survival risks in patients undergoing abdominoperineal resection and sphincter-saving operation for rectal cancer: a 10-year cohort analysis using propensity score matching. Int J Colorectal Dis 2022; 37:989-997. [PMID: 35378615 DOI: 10.1007/s00384-022-04138-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Abdominoperineal resection (APR) has been considered to have a higher risk of local recurrence and poorer survival outcome than sphincter-saving operation (SSO) in patients with rectal cancer. This study compared long-term oncologic outcomes and prognostic parameters in propensity score-matched patients who underwent APR and SSO. METHODS This study analyzed 958 consecutive patients with lower rectal cancer who underwent preoperative chemoradiotherapy followed by APR or SSO between 2005 and 2015. Propensity score matching analysis was performed to adjust baseline characteristics, including clinical stage, tumor distance from the anal verge, and tumor size. RESULTS In the entire cohort, the APR group had larger and lower tumors and showed significantly shorter 5-year disease-free survival (DFS) than the SSO group (64.5% vs. 75.8%, p = 0.01). After propensity score matching, there were no significant between-group differences in local (9.5% vs. 8.0%, p = 0.59) and systemic (27.9% vs. 23.4%, p = 0.3) recurrence rates, and 5-year DFS (67.5% vs. 69.9%, p = 0.49) and overall survival (80.8% vs. 82.9%, p = 0.65) rates. A lower number of lymph nodes retrieved was independently associated with recurrence and survival outcomes in the APR group, whereas poorly differentiated histology was an independent associated parameter in the SSO group. Advanced stage and perineural invasion were identified as independent prognostic parameters in both groups. CONCLUSIONS This study indicated that the long-term oncologic outcomes of APR were comparable to those of SSO. Because prognostic parameters associated with oncologic outcomes differed between the respective procedures, correctable parameters could be ameliorated through complete total mesorectal excision and personalized systemic treatment.
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12
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Quality of life in a randomized trial comparing two neoadjuvant regimens for locally advanced rectal cancer-INCAGI004. Support Care Cancer 2022; 30:6557-6572. [PMID: 35486228 DOI: 10.1007/s00520-022-07059-6] [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: 09/29/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (neoCRT) followed by surgery is the standard of care for locally advanced rectal cancer (LARC), but the emergence of different drug regimens may result in different response rates. Good clinical response translates into greater sphincter preservation, but quality of life (QOL) may be impaired after treatment due to chemoradiotherapy and surgical side effects. OBJECTIVE To prospectively evaluate the impact of clinical response and surgical resection on QOL in a randomized trial comparing two different neoCRT regimens. METHODS Stage II and III rectal cancer patients were randomized to receive neoCRT with either capecitabine (group 1) or 5-Fu and leucovorin (group 2) concomitant to long-course radiotherapy. Clinical downstaging was accessed using MRI 6-8 weeks after treatment. EORTCs QLQ-C30 and CR38 were applied before treatment (T0), after neoCRT (T1), after rectal resection (T2), early after adjuvant chemotherapy (T3), and 1 year after the end of treatment or stoma closure (T4). The Wexner scale was used for fecal incontinence evaluation at T4. A C30SummaryScore (Geisinger and cols.) was calculated to compare QOL results. RESULTS Thirty-two patients were assigned to group 1 and 31 to group 2. Clinical downstaging occurred in 70.0% of group 1 and 53.3% of group 2 (p = 0.288), and sphincter preservation was 83.3% in group 1 and 80.0% in group 2 (p = 0.111). No significant difference in QOL was detected when comparing the two treatment groups after neoCRT using QLQ-C30. However, the CR38 module detected differences in micturition problems (15.3 points), gastrointestinal problems (15.3 points), defecation problems (11.8 points), and sexual satisfaction (13.3 points) favoring the capecitabine group. C30SummaryScore detected significant improvement comparing T0 to T1 and deterioration comparing T1 to T2 (p = 0.025). The mean Wexner scale score was 9.2, and a high score correlated with symptoms of diarrhea and defecation problems at T4. CONCLUSIONS QOL was equivalent between groups after neoCRT except for micturition problems, gastrointestinal problems, defecation problems, and sexual satisfaction favoring the capecitabine arm after. The overall QOL using the C30SummaryScore was improved after neoCRT, but decreased following rectal resection, returning to basal levels at late evaluation. Fecal incontinence was high after sphincter preservation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03428529.
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13
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Arslani N, Rachimis PR, Marolt U, Krebs B. Distal Surgical Margin in Rectal Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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Algie JPA, van Kooten RT, Tollenaar RAEM, Wouters MWJM, Peeters KCMJ, Dekker JWT. Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life. Int J Colorectal Dis 2022; 37:2197-2205. [PMID: 36156128 PMCID: PMC9560940 DOI: 10.1007/s00384-022-04257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical resection is the mainstay of curative treatment for rectal cancer. Post-operative complications, low anterior resection syndrome (LARS), and the presence of a stoma may influence the quality of life after surgery. This study aimed to gain more insights into the long-term trade-off between stoma and anastomosis. METHODS All patients who underwent sphincter-sparing surgical resection for rectal cancer in the Leiden University Medical Center and the Reinier de Graaf Gasthuis between January 2012 and January 2016 were included. Patients received the following questionnaires: EORTC-QLQ-CR29, EORTC-QLQ-C30, EQ-5D-5L, and the LARS score. A comparison was made between patients with a stoma and without a stoma after follow-up. RESULTS Some 210 patients were included of which 149 returned the questionnaires (70.9%), after a mean follow-up of 3.69 years. Overall quality of life was not significantly different in patients with and without stoma after follow-up using the EORTC-QLQ-C30 (p = 0.15) or EQ-5D-5L (p = 0.28). However, after multivariate analysis, a significant difference was found for the presence of a stoma on global health status (p = 0.01) and physical functioning (p < 0.01). Additionally, there was no difference detected in the quality of life between patients with major LARS or a stoma. CONCLUSION This study shows that after correction for possible confounders, a stoma is associated with lower global health status and physical functioning. However, no differences were found in health-related quality of life between patients with major LARS and patients with a stoma. This suggests that the choice between stoma and anastomosis is mainly preferential and that shared decision-making is required.
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Affiliation(s)
- Jelle P. A. Algie
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
| | - Robert T. van Kooten
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
| | - Rob A. E. M. Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
| | - Michel W. J. M. Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands ,Department of Surgery, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Koen C. M. J. Peeters
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
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15
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Lawday S, Flamey N, Fowler GE, Leaning M, Dyar N, Daniels IR, Smart NJ, Hyde C. Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review. BJS Open 2021; 5:6510905. [PMID: 35040944 PMCID: PMC8765336 DOI: 10.1093/bjsopen/zrab101] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background Low rectal cancers could be treated using restorative (anterior resection, AR) or non-restorative procedures with an end/permanent stoma (Hartmann’s, HE; or abdominoperineal excision, APE). Although the surgical choice is determined by tumour and patient factors, quality of life (QoL) will also influence the patient's future beyond cancer. This systematic review of the literature compared postoperative QoL between the restorative and non-restorative techniques using validated measurement tools. Methods The review was registered on PROSPERO (CRD42020131492). Embase and MEDLINE, along with grey literature and trials websites, were searched comprehensively for papers published since 2012. Inclusion criteria were original research in an adult population with rectal cancer that reported QoL using a validated tool, including the European Organization for Research and Treatment of Cancer QLQ-CR30, QLQ-CR29, and QLQ-CR38. Studies were included if they compared AR with APE (or HE), independent of study design. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Outcomes of interest were: QoL, pain, gastrointestinal (GI) symptoms (stool frequency, flatulence, diarrhoea and constipation), and body image. Results Nineteen studies met the inclusion criteria with a total of 6453 patients; all papers were observational and just four included preoperative evaluations. There was no identifiable difference in global QoL and pain between the two surgical techniques. Reported results regarding GI symptoms and body image documented similar findings. The ROBINS-I tool highlighted a significant risk of bias across the studies. Conclusion Currently, it is not possible to draw a firm conclusion on postoperative QoL, pain, GI symptoms, and body image following restorative or non-restorative surgery. The included studies were generally of poor quality, lacked preoperative evaluations, and showed considerable bias in the data.
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Affiliation(s)
- Samuel Lawday
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK.,Bristol Centre for Surgical Research, University of Bristol, Bristol, UK.,College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - George E Fowler
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK.,Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | | | - Nadine Dyar
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK
| | | | - Neil J Smart
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK.,College of Medicine and Health, University of Exeter, Exeter, UK
| | - Christopher Hyde
- College of Medicine and Health, University of Exeter, Exeter, UK
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16
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Verweij ME, Hoendervangers S, Couwenberg AM, Burbach JPM, Berbee M, Buijsen J, Roodhart J, Reerink O, Pronk A, Consten ECJ, Smits AB, Heikens JT, van Grevenstein WMU, Intven MPW, Verkooijen HM. Impact of dose-escalated chemoradiation on quality of life in patients with locally advanced rectal cancer: two year follow-up of the randomized RECTAL-BOOST trial. Int J Radiat Oncol Biol Phys 2021; 112:694-703. [PMID: 34634436 DOI: 10.1016/j.ijrobp.2021.09.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dose-escalated chemoradiation (CRT) for locally advanced rectal cancer (LARC) did not result in higher complete response rates, but initiated more tumor regression in the randomized XXXXX trial (Clinicaltrials.gov XXXXX). This study compared patient reported outcomes (PROs) between patients who received dose-escalated CRT (5 × 3Gy boost + CRT) or standard CRT for two years following randomization. METHODS Patients with LARC, participating in the XXXXX trial, filled out EORTC QLQ-C30 and CR29 questionnaires on quality of life (QoL) and symptoms at baseline, 3, 6, 12, 18 and 24 months following start of treatment. Between-group differences in functional QoL domains were estimated using a linear mixed-effects model and expressed as effect size (ES). Symptom scores were compared using Mann-Whitney U test. RESULTS Patients treated with dose-escalated CRT (boost group, n=51) experienced a significantly stronger decline in global health at 3 and 6 months (ES -0,4 and ES -0,4), physical functioning at 6 months (ES -1,1), role functioning at 3 and 6 months (ES -0,8 and ES -0,6) and social functioning at 6 months (ES -0,6) compared to patients treated with standard CRT (control group, n=64). The boost group reported significantly more fatigue at 3 and 6 months (83% vs. 66% resp. 89% vs. 76%), pain at 3 and 6 months (67% vs. 36% resp. 80% vs. 44%) and diarrhea at 3 months (45% vs. 29%) compared to the control group. From 12 months onwards, QoL and symptoms were similar between groups, apart from more blood/mucus in stool in the boost group. CONCLUSION In patients with LARC, dose-escalated CRT resulted in a transient deterioration in global health, physical, role, and social functioning and more pain, fatigue and diarrhea at 3 and 6 months following start of treatment compared to standard CRT. From 12 months onwards, the impact of dose-escalated CRT on QoL largely resolved.
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Affiliation(s)
- M E Verweij
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S Hoendervangers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A M Couwenberg
- Department of Radiation Oncology, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - J P M Burbach
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - M Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Buijsen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - O Reerink
- Department of Radiation Oncology, Isala Clinic, Zwolle, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J T Heikens
- Department of Surgery, Hospital Rivierenland, Tiel, The Netherlands
| | | | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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17
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Cui CL, Luo WY, Cosman BC, Eisenstein S, Simpson D, Ramamoorthy S, Murphy J, Lopez N. Cost Effectiveness of Watch and Wait Versus Resection in Rectal Cancer Patients with Complete Clinical Response to Neoadjuvant Chemoradiation. Ann Surg Oncol 2021; 29:1894-1907. [PMID: 34529175 PMCID: PMC8810473 DOI: 10.1245/s10434-021-10576-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 06/22/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Watch and wait (WW) protocols have gained increasing popularity for patients diagnosed with locally advanced rectal cancer and presumed complete clinical response after neoadjuvant chemoradiation. While studies have demonstrated comparable survival and recurrence rates between WW and radical surgery, the decision to undergo surgery has significant effects on patient quality of life. We sought to conduct a cost-effectiveness analysis comparing WW with abdominoperineal resection (APR) and low anterior resection (LAR) among patients with stage II/III rectal cancer. METHODS In this comparative-effectiveness study, we built Markov microsimulation models to simulate disease progression, death, costs, and quality-adjusted life-years (QALYs) for WW or APR/LAR. We assessed cost effectiveness using the incremental cost-effectiveness ratio (ICER), with ICERs under $100,000/QALY considered cost effective. Probabilities of disease progression, death, and health utilities were extracted from published, peer-reviewed literature. We assessed costs from the payer perspective. RESULTS WW dominated both LAR and APR at a willingness to pay (WTP) threshold of $100,000. Our model was most sensitive to rates of distant recurrence and regrowth after WW. Probabilistic sensitivity analysis demonstrated that WW was the dominant strategy over both APR and LAR over 100% of iterations across a range of WTP thresholds from $0-250,000. CONCLUSIONS Our study suggests WW could reduce overall costs and increase effectiveness compared with either LAR or APR. Additional clinical research is needed to confirm the clinical efficacy and cost effectiveness of WW compared with surgery in rectal cancer.
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Affiliation(s)
- Christina Liu Cui
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - William Yu Luo
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Bard Clifford Cosman
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Diego Health Systems, La Jolla, CA, 92093-0987, USA.,Veterans Affairs San Diego Medical Center, San Diego, CA, USA
| | - Samuel Eisenstein
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Diego Health Systems, La Jolla, CA, 92093-0987, USA
| | - Daniel Simpson
- Department of Radiation Medicine and Applied Science, University of California, San Diego, La Jolla, CA, USA
| | - Sonia Ramamoorthy
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Diego Health Systems, La Jolla, CA, 92093-0987, USA
| | - James Murphy
- Department of Radiation Medicine and Applied Science, University of California, San Diego, La Jolla, CA, USA
| | - Nicole Lopez
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Diego Health Systems, La Jolla, CA, 92093-0987, USA.
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18
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Walker BS, Sutton TL, Zarour L, Hunter JG, Wood SG, Tsikitis VL, Herzig DO, Lopez CD, Chen EY, Mayo SC, Wong MH. Circulating Hybrid Cells: A Novel Liquid Biomarker of Treatment Response in Gastrointestinal Cancers. Ann Surg Oncol 2021; 28:8567-8578. [PMID: 34365557 DOI: 10.1245/s10434-021-10379-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Real-time monitoring of treatment response with a liquid biomarker has potential to inform treatment decisions for patients with rectal adenocarcinoma (RAC), esophageal adenocarcinoma (EAC), and colorectal liver metastasis (CRLM). Circulating hybrid cells (CHCs), which have both immune and tumor cell phenotypes, are detectable in the peripheral blood of patients with gastrointestinal cancers, but their potential as an indicator of treatment response is unexplored. METHODS Peripheral blood specimens were collected from RAC and EAC patients after neoadjuvant therapy (NAT) or longitudinally during therapy and evaluated for CHC levels by immunostaining. Receiver operating characteristics (ROCs) and the Kaplan-Meier method were used to analyze the CHC level as a predictor of pathologic response to NAT and disease-specific survival (DSS), respectively. RESULTS Patients with RAC (n = 23) and EAC (n = 34) were sampled on the day of resection, and 11 patients (32%) demonstrated a pathologic complete response (pCR) to NAT. On ROC analysis, CHC levels successfully discriminated pCR from non-pCR with an area under the curve of 0.82 (95% confidence interval [CI], 0.71-0.92; P < 0.001). Additionally, CHC levels in the EAC patients correlated with residual nodal involvement (P = 0.026) and 1-year DSS (P = 0.029). The patients with RAC who were followed longitudinally during NAT (n = 2) and hepatic arterial infusion therapy for CRLM (n = 2) had CHC levels that decreased with therapy response and increased before clinical evidence of disease progression. CONCLUSION Circulating hybrid cells are a novel blood-based biomarker with potential for monitoring treatment response and disease progression to help guide decisions for further systemic therapy, definitive resection, and post-therapy surveillance. Additional validation studies of CHCs are warranted.
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Affiliation(s)
- Brett S Walker
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA
| | - Thomas L Sutton
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA
| | - Luai Zarour
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA
| | - John G Hunter
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA.,Knight Cancer Institute, Portland, OR, USA
| | - Stephanie G Wood
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA
| | - V Liana Tsikitis
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA.,Knight Cancer Institute, Portland, OR, USA
| | - Daniel O Herzig
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA
| | - Charles D Lopez
- Knight Cancer Institute, Portland, OR, USA.,Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health and Science University (OHSU), Portland, OR, 97239, USA
| | - Emerson Y Chen
- Knight Cancer Institute, Portland, OR, USA.,Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, 2720 South Moody Aveune, Mailcode KC-CDCB, Portland, OR, 97201, USA
| | - Skye C Mayo
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, OR, USA.,Knight Cancer Institute, Portland, OR, USA
| | - Melissa H Wong
- Knight Cancer Institute, Portland, OR, USA. .,Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, 2720 South Moody Aveune, Mailcode KC-CDCB, Portland, OR, 97201, USA.
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19
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Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer. Chin Med J (Engl) 2021; 133:1824-1833. [PMID: 32604174 PMCID: PMC7469998 DOI: 10.1097/cm9.0000000000000852] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients’ quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.
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20
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Sun G, Lou Z, Zhang H, Yu GY, Zheng K, Gao XH, Meng RG, Gong HF, Furnée EJB, Bai CG, Zhang W. Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer. Tech Coloproctol 2020; 24:1025-1034. [PMID: 32361871 PMCID: PMC7522072 DOI: 10.1007/s10151-020-02229-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4-5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. METHODS Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. RESULTS A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3-4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3-0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12-45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. CONCLUSIONS For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.
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Affiliation(s)
- G Sun
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Z Lou
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - H Zhang
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - G Y Yu
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - K Zheng
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - X H Gao
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - R G Meng
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - H F Gong
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - E J B Furnée
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - C G Bai
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - W Zhang
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China.
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21
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Kadota T, Ikematsu H, Sasaki T, Saito Y, Ito M, Mizutani T, Ogawa G, Shitara K, Ito Y, Kushima R, Kanemitsu Y, Muto M. Protocol for a single-arm confirmatory trial of adjuvant chemoradiation for patients with high-risk rectal submucosal invasive cancer after local resection: Japan Clinical Oncology Group Study JCOG1612 (RESCUE study). BMJ Open 2020; 10:e034947. [PMID: 32665384 PMCID: PMC7365419 DOI: 10.1136/bmjopen-2019-034947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Intestinal resection with lymph node dissection is the current standard treatment for high-risk lower rectal submucosal invasive cancer after local resection; however, surgery affects patients' quality of life due to stoma placement or impaired anal sphincter function. A recent study demonstrated that adjuvant chemoradiation yields promising results. METHODS AND ANALYSIS This study aims to confirm the non-inferiority of adjuvant chemoradiation, consisting of capecitabine and concurrent radiotherapy (45 Gy in 25 fractions), measured by 5-year relapse-free survival (RFS), over standard surgery in patients with high-risk lower rectal submucosal invasive cancer after local resection. The primary endpoint is 5 year RFS. The secondary endpoints are 10 years RFS, 5-year and 10-year overall survival, 5-year and 10-year local RFS, 5-year and 10-year proportion of anus-preservation without stoma, Wexner score, low anterior resection syndrome score, adverse events and serious adverse events. During the 5-year trial period, 210 patients will be accrued from 65 Japanese institutions. ETHICS AND DISSEMINATION The National Cancer Center Hospital East Certified Review Board approved this study protocol in October 2018. The study is conducted in accordance with the precepts established in the Declaration of Helsinki and Clinical Trials Act. Written informed consent will be obtained from all eligible patients prior to registration. The primary results of this study will be published in an English article. In addition, the main results will be published on the websites of Japan Clinical Oncology Group (www.jcog.jp) and jRCT (https://jrct.niph.go.jp/). As to data curation, it has not been prepared yet. TRIAL REGISTRATION NUMBER jRCT1031180076.
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Affiliation(s)
- Tomohiro Kadota
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Chuo-ku, Japan
- Department of Gastroenterology and Endoscopy, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Tomonori Mizutani
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Gakuto Ogawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Chuo-ku, Japan
| | - Kohei Shitara
- Department of Gastroenterology and Endoscopy, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University Graduate School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine (Diagnostic Pathology), Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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22
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Anorectal Function Recovery Curve of the Patients with Different Tumor Locations After Sphincter-Saving Resection for Low Rectal Cancer. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01958-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Yang W, Huang L, Chen P, Yang Y, Liu X, Wang C, Yu Y, Yang L, Wang Z, Zhou Z. A controlled study on the efficacy and quality of life of laparoscopic intersphincteric resection (ISR) and extralevator abdominoperineal resection (ELAPE) in the treatment of extremely low rectal cancer. Medicine (Baltimore) 2020; 99:e20245. [PMID: 32481390 DOI: 10.1097/md.0000000000020245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the postoperative quality of life (QoL) and survival outcomes in lower rectal cancer (LRC) patients who undergo either laparoscopic- intersphincteric resection or extralevator abdominoperineal excision (L-ELAPE) after long-course neoadjuvant chemoradiation therapy (nCRT). METHODS This prospective, single-center, non-randomized, controlled, non-blinded, phase I/II clinical trial is designed to enroll 159 eligible LRC patients who achieved favorable response to long-course nCRT (2 × 25 Gy). After informed consent, the patients will be assigned into the laparoscopic intersphincteric resection group or L-ELAPE group according to their own will. Standard radical laparoscopic surgeries will be performed for every participant. Then every participant will be followed up for 3 years. The primary outcomes are scores of QoL questionnaire-core 30, QoL questionnaire-colorectum 29, Wexner incontinence score, International Prostate Symptom Score (for male), International Index of Erectile Function-5 (for male) and Female Sexual Function Index (for female). The secondary outcomes consist of incomplete circumferential resection margin rate, 3-year local recurrence, 3-year disease-free survival, 3-year overall survival and other surgical outcomes. DISCUSSION This is the first prospective clinical controlled trial to assess postoperative QoL and efficacy for LRC patients after favorable long-course nCRT. The result is expected to provide new evidence for a more detailed individualized treatment guideline for LRC. TRIAL REGISTRATION This trial was registered at Chinese Clinical Trial Registry (ChiCTR1800017512; ChiCTR.org) on August 2, 2018.
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Affiliation(s)
- Wenming Yang
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
| | - Libin Huang
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
| | - Peng Chen
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
| | - Yun Yang
- Department of General Surgery, West China-Shangjin Hospital of Sichuan University/Chengdu Shangjin Nanfu Hospital, No. 253 Shangjin Road, Chengdu, China
| | - Xueting Liu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Chengdu
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University
| | - Yongyang Yu
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University
- Department of General Surgery, West China-Ziyang Hospital of Sichuan University/The First People's Hospital of Ziyang, No. 66 Rende West Road, Ziyang
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University
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24
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Peng B, Lu J, Wu Z, Li G, Wei F, Cao J, Li W. Intersphincteric Resection Versus Abdominoperineal Resection for Low Rectal Cancer: A Meta-Analysis. Surg Innov 2020; 27:392-401. [PMID: 32390544 DOI: 10.1177/1553350620918414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background. Abdominoperineal resection (APR) has been the standard surgery for ultra-low rectal cancer for a century. In recent years, intersphincteric resection (ISR) has been increasingly used to avoid the permanent colostomy. Up to now, there is no relevant meta-analysis comparing the clinical efficacy of ISR and APR. This meta-analysis aimed to compare the outcomes of these 2 procedures. Methods. A comprehensive search of online databases was performed on PubMed, EMBASE, and the Cochrane Library to obtain comparative studies of ISR and APR. Then the data from studies that met the inclusion criteria were extracted and analyzed. Results. A total of 12 studies covering 2438 patients were included. No significant differences were found between ISR and APR in gender, body mass index, distance from tumor to anal edge, operative time, and blood loss. In addition, hospital stay (weighted mean differences = -2.98 days; 95% confidence interval [CI] = -3.54 to -2.43; P < .00001) and postoperative morbidity (odds ratio [OR] = 0.76; 95% CI = 0.59 to 0.99; P = .04) were significantly lower in ISR group compared with APR group. However, patients who underwent ISR showed lower pathological T-stage (T3T4%, OR = 0.49; 95% CI = 0.28 to 0.86; P = .01) and lymph node metastasis rate (OR = 0.77; 95% CI = 0.59 to 1.01; P = .06) compared with those who underwent APR. Moreover, oncological outcomes were similar between the 2 groups. Conclusion. ISR may provide a safe alternative to APR, with shorter hospital stays, lower postoperative morbidity, and similar oncological outcomes. Well-designed randomized controlled trials are needed to confirm and update the findings of this analysis.
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Affiliation(s)
- Baifu Peng
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiabao Lu
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zixin Wu
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Guanwei Li
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Fang Wei
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Jie Cao
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Wanglin Li
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
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25
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Bellezzo M, Fonseca GP, Voncken R, Verrijssen AS, Van Beveren C, Roelofs E, Yoriyaz H, Reniers B, Van Limbergen EJ, Berbée M, Verhaegen F. Advanced design, simulation, and dosimetry of a novel rectal applicator for contact brachytherapy with a conventional HDR 192Ir source. Brachytherapy 2020; 19:544-553. [PMID: 32386884 DOI: 10.1016/j.brachy.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Dose escalation yields higher complete response to rectal tumors, which may enable the omission of surgery. Dose escalation using 50 kVp contact x-ray brachytherapy (CXB) allow the treatment of a selective volume, resulting in low toxicity and organs-at-risk preservation. However, the use of CXB devices is limited because of its high cost and lack of treatment planning tools. Hence, the MAASTRO applicator (for HDR 192Ir sources) was developed and characterized by measurements and Monte Carlo simulations to be a cost-effective alternative to CXB devices. METHODS AND MATERIALS A cylindrical applicator with lateral shielding was designed to be used with a rectoscope using its tip as treatment surface. Both the applicator and the rectoscope have a slanted edge to potentially allow easier placement against tumors. The applicator design was achieved by Monte Carlo modeling and validated experimentally with film dosimetry, using the Papillon 50 (P50) device as reference. RESULTS The applicator delivers CXB doses in less than 9 min using a 20375 U source for a treatment area of approximately 20 × 20 mm2 at 2 mm depth. Normalized at 2 mm, the dose falloff for depths of 0 mm, 5 mm, and 10 mm are 130%, 70%, and 43% for the P50 and 140%, 67%, and 38% for the MAASTRO applicator, respectively. CONCLUSIONS The MAASTRO applicator was designed to use HDR 192Ir sources to deliver a dose distribution similar to those of CXB devices. The applicator may provide a cost-effective solution for endoluminal boosting with clinical treatment planning system integration.
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Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - An-Sofie Verrijssen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Celine Van Beveren
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hélio Yoriyaz
- Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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26
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Kim CW, Jeong WK, Son GM, Kim IY, Park JW, Jeong SY, Park KJ, Lee SH. Validation of Korean Version of Low Anterior Resection Syndrome Score Questionnaire. Ann Coloproctol 2020; 36:83-87. [PMID: 32054239 PMCID: PMC7299562 DOI: 10.3393/ac.2019.08.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose Patients who undergo radical surgery for rectal cancer often experience low anterior resection syndrome (LARS). Symptoms of this syndrome include frequent bowel movements, gas incontinence, fecal incontinence, fragmentation, and urgency. The aim of this study was to investigate the convergent validity, discriminative validity, and reliability of the Korean version of the LARS score questionnaire. Methods The English LARS score questionnaire was translated into Korean using the forward-and-back translation method. A total of 146 patients who underwent radical surgery for rectal cancer answered the Korean version of the LARS score questionnaire including an anchor question assessing the impact of bowel function. Participants answered the questionnaire once more after 2 weeks. Results The Korean LARS score questionnaire showed high convergent validity in terms of high correlation between the LARS score and quality of life (perfect fit 55.5% vs. moderate fit 37.6% vs. no fit 6.8%, respectively; P < 0.001). The LARS score also showed good discriminative validity between groups of patients differing by sex (29 for males vs. 25 for females; P = 0.014), tumor level (29 for ≤8 cm vs. 24 for >8 cm; P = 0.021), and radiotherapy (32 for yes vs. 24 for no; P = 0.001). The LARS score also demonstrated high reliability at test-retest with no difference between scores at the first and second tests (intraclass correlation coefficient: Q1 = 0.932; Q2 = 0.909, Q3 = 0.944, Q4 = 0.931, and Q5 = 0.942; P < 0.001, respectively). Conclusion The Korean version of the LARS score questionnaire has proven to be a valid and reliable tool for measuring LARS in Korean patients with rectal cancer.
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Affiliation(s)
- Chang Woo Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan University College of Medicine, Yangsan, Korea
| | - Ik Yong Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Suk-Hwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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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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28
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Kim JC, Lee JL, Bong JW, Seo JH, Kim CW, Park SH, Kim J. Oncological and anorectal functional outcomes of robot-assisted intersphincteric resection in lower rectal cancer, particularly the extent of sphincter resection and sphincter saving. Surg Endosc 2019; 34:2082-2094. [DOI: 10.1007/s00464-019-06989-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/15/2019] [Indexed: 01/06/2023]
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29
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Jeong H, Park J. Factors influencing changing bowel habits in patients undergoing sphincter-saving surgery for rectal cancer. Int Wound J 2019; 16 Suppl 1:71-75. [PMID: 30793858 DOI: 10.1111/iwj.13060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/06/2018] [Indexed: 12/15/2022] Open
Abstract
A research survey research was conducted to identify factors affecting changes in bowel habits of rectal cancer patients undergoing sphincter-saving surgery and to provide basic information useful in nursing interventions supporting treatment for rectal cancer patients. The subjects were rectal cancer patients who had undergone sphincter-saving surgery over 2 years ago. The final analysis included 107 patients who had made outpatient visits to the colorectal surgery from 12th to 31st May, 2014. Collected data were processed with SPSS Version 21.0. Changes in bowel habits in the subjects were observed: frequent bowel movement in 74 patients (69.2%) and faecal incontinence in 48 (44.9%). Most of the patients used self-care to improve their bowel function including dietary modification (78.5%), regular exercise (72.0%) and pelvic floor exercise (34.6%). Frequent defecation was associated with adjuvant chemoradiation therapy (P < 0.001) and faecal incontinence was associated with age of ≥65 years (P = 0.019) and a group who underwent adjuvant radiation therapy (P < 0.001). It is necessary to give sufficient information about possible postoperative changes in bowel habits to patients with the risk factors before surgery.
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Affiliation(s)
- Hyeonju Jeong
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, South Korea
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Long-term Outcomes After Surgery Involving the Pelvic Floor in Rectal Cancer: Physical Activity, Quality of Life, and Health Status. J Gastrointest Surg 2019; 23:808-817. [PMID: 30374817 DOI: 10.1007/s11605-018-4014-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 10/12/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE This study has aimed to evaluate the effects of surgery on physical activity (PA), quality of life (QoL), and disease-specific health status, by analyzing the differences between sphincter-preserving surgery (low anterior resection (LAR)) and abdominoperineal resection (APR) among rectal cancer survivors. METHODS Individuals who were diagnosed with rectal cancer and who underwent an APR or a LAR between 2000 and 2009 were included. The different questionnaires on QoL, disease-specific health status, and physical activity began their surveys in 2010. Differences in QoL, health status, and physical activity were analyzed between the APR group and the LAR group. RESULTS The study included 905 rectal cancer survivors (LAR, 632; APR, 273). Besides a higher rate of radiotherapy treatment in the APR group (94% vs. 75%, p < 0.001), there were no differences in clinical characteristics or in comorbid conditions between the LAR group and APR group. No significant differences were found in PA level between the patients who had undergone an APR vs. a LAR. Regarding QoL, APR patients did report a worse physical (p = 0.009) and role functioning (p = 0.03), as well as a worse body image (p = 0.001), compared to patients who had undergone a LAR. However, they reported fewer constipation (p = 0.02) and gastrointestinal problems (p = 0.009). Finally, compared to patients who had undergone a LAR with a permanent ostomy, APR patients reported a better body image (p = 0.048) and less stoma-related problems (p = 0.001). CONCLUSIONS This study showed no differences in PA level among the patients who had undergone an APR versus a LAR. With respect to their QoL, their physical and role functioning seemed to be worse in the APR patients. However, these differences in outcomes resolved when comparing the APR group with patients after a LAR with a permanent ostomy.
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Etiology and management of low anterior resection syndrome based on the normal defecation mechanism. Surg Today 2019; 49:803-808. [PMID: 30937634 DOI: 10.1007/s00595-019-01795-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/07/2019] [Indexed: 12/27/2022]
Abstract
Low anterior resection syndrome (LARS) commonly develops after an anal sphincter-preserving operation (SPO). The etiology of LARS is not well understood, as the anatomical components and physiological function of normal defecation, which may be damaged during the SPO, are not well established. SPOs may damage components of the anal canal (such as the internal anal sphincter, longitudinal conjoint muscle, or hiatal ligament), either mechanically or via injury to the nerves that supply these organs. The function of the rectum is substantially impaired by resection of the rectum, division of the rectococcygeus muscle, and/or injury of the nervous supply. When the remnant rectum is small and does not function properly, an important functional role may be played by the neorectum, which is usually constructed from the left side of the colon. Hypermotility of the remnant colon may affect the manifestation of urge fecal incontinence. To develop an SPO that minimizes the risk of LARS, the anatomy and physiology of the structures involved in normal defecation need to be understood better. LARS is managed similarly to fecal incontinence. In particular, management should focus on reducing colonic motility when urge fecal incontinence is the dominant symptom.
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Lightner AL, Spinelli A, McKenna NP, Hallemeier CL, Fleshner P. Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi-institution collaborative study. Colorectal Dis 2019; 21:219-225. [PMID: 30411480 DOI: 10.1111/codi.14467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/17/2018] [Indexed: 02/08/2023]
Abstract
AIM Short-term morbidity and long-term functional outcome of patients with an ileal pouch-anal anastomosis (IPAA) exposed to pelvic external beam radiation therapy (EBRT) remains unknown. We report the largest series to date regarding the effects of pelvic EBRT on: (i) 30-day postoperative outcomes; and (ii) long-term functional outcome following IPAA. METHOD A retrospective chart review was conducted of patients who received EBRT before or after IPAA between 1980 and 2017 across three international inflammatory bowel disease referral centres. RESULTS Nineteen patients were included. Indications for EBRT were rectal adenocarcinoma (n = 13), prostate adenocarcinoma (n = 4) or anal squamous cell carcinoma (ASCC) (n = 2). EBRT was given prior to IPAA in 12 (63%) patients and after IPAA in seven (37%). In EBRT before IPAA, patients had a median of 5 (range: 4-8) daytime bowel movements, 1 (range: 0-5) night-time bowel movement, no daytime incontinence, and only one patient used pads at a median follow up of 25 (range: 11-163) months; one patient underwent pouch excision 15 months after IPAA. In EBRT after IPAA, patients reported a median of 8 (range: 5-10) daytime and 2 (range: 0-5) night-time bowel movements, 80% had either daytime or night-time incontinence and 80% used pads at a median follow up of 90 (range: 25-315) months. CONCLUSION Pelvic EBRT administered prior to IPAA is associated with acceptable long-term function outcome. However, when pelvic EBRT is given to an IPAA in situ, most patients experience poor long-term pouch function without pouch failure.
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Affiliation(s)
- A L Lightner
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A Spinelli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.,Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - N P McKenna
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - C L Hallemeier
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - P Fleshner
- Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Verrijssen AS, Opbroek T, Bellezzo M, Fonseca GP, Verhaegen F, Gerard JP, Sun Myint A, Van Limbergen EJ, Berbee M. A systematic review comparing radiation toxicity after various endorectal techniques. Brachytherapy 2019; 18:71-86.e5. [DOI: 10.1016/j.brachy.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 01/29/2023]
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Rubinkiewicz M, Zarzycki P, Czerwińska A, Wysocki M, Gajewska N, Torbicz G, Budzyński A, Pędziwiatr M. A quest for sphincter-saving surgery in ultralow rectal tumours-a single-centre cohort study. World J Surg Oncol 2018; 16:218. [PMID: 30404633 PMCID: PMC6223085 DOI: 10.1186/s12957-018-1513-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Despite the progress in the treatment of colorectal cancer, there is still no optimal strategy for tumours located adjacent to the anal sphincter. This study aims to evaluate oncological and functional results of surgery for rectal cancer in unfavourable locations in proximity to anal sphincters. MATERIALS AND METHODS Patients with rectal cancer, which was either initially infiltrating the anal sphincter or located in the close proximity of the sphincter, were included in the study. Patients were submitted to extralevator abdominoperineal resection (APR), intersphincteric resection, or transanal total mesorectal excision (TaTME). Primary outcomes were perioperative data: operative time, blood loss, complications, length of stay (LOS), and 30-day mortality. Secondary outcomes were pathological quality of the specimens and functional outcome 6 months after defunctioning ileostomy closure. RESULTS Among patients with cancer adjacent to the anal sphincter, 13 (25%) underwent APR, 14 (27%) patients were submitted to intersphincteric resection, and 25 (48%) patients were treated with the TaTME approach. Operative time was 240 (210-270 IQR) for APR, 212.5 (170-260 IQR) for intersphincteric resection, and 270 (240-330 IQR) for TaTME (p = 0.018). Perioperative morbidity was 31% for APR, 36% for intersphincteric resections, and 12% for the TaTME group (p = 0.181). Complete mesorectal excision was achieved in 92% of specimens in the TaTME group, 93% in intersphincteric resections, and 78% in the APR group (p = 0.72). Median circumferential resection margin in APR was 6 mm (4-7 IQR), in intersphincteric resections 7.5 mm (2.5-10 IQR), and in the TaTME group 4 mm (2.8-8 IQR). All patients after intersphincteric resections developed major low anterior resection syndrome (LARS). Four patients in the TaTME group developed minor LARS, and 21 had major LARS. CONCLUSION Sphincter-saving rectal resections are a feasible alternative to APR with good clinical, pathological, and oncological outcomes. Intersphincteric resections and TaTME seem to be equal in terms of clinicopathological results. The functional outcome is yet to be investigated. TRIAL REGISTRATION The study was retrospectively registered in Thai Clinical Trials Registry (23-07-2018, ID TCTR20180724001 ).
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Affiliation(s)
- Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Piotr Zarzycki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Agata Czerwińska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Grzegorz Torbicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
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Evaluation of Sexual Satisfaction and Function in Patients Following Stoma Surgery: A Descriptive Study. SEXUALITY AND DISABILITY 2018. [DOI: 10.1007/s11195-018-9544-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bellezzo M, Fonseca GP, Verrijssen AS, Voncken R, Van den Bosch MR, Yoriyaz H, Reniers B, Berbée M, Van Limbergen EJ, Verhaegen F. A novel rectal applicator for contact radiotherapy with HDR 192Ir sources. Brachytherapy 2018; 17:1037-1044. [PMID: 30122346 DOI: 10.1016/j.brachy.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Dose escalation to rectal tumors leads to higher complete response rates and may thereby enable omission of surgery. Important advantages of endoluminal boosting techniques include the possibility to apply a more selective/localized boost than using external beam radiotherapy. A novel brachytherapy (BT) rectal applicator with lateral shielding was designed to be used with a rectoscope for eye-guided positioning to deliver a dose distribution similar to the one of contact x-ray radiotherapy devices, using commonly available high-dose-rate 192Ir BT sources. METHODS AND MATERIALS A cylindrical multichannel BT applicator with lateral shielding was designed by Monte Carlo modeling, validated experimentally with film dosimetry and compared with results found in the literature for the Papillon 50 (P50) contact x-ray radiotherapy device regarding rectoscope dimensions, radiation beam shape, dose fall-off, and treatment time. RESULTS The multichannel applicator designed is able to deliver 30 Gy under 13 min with a 20350 U (5 Ci) source. The use of multiple channels and lateral shielding provide a uniform circular treatment surface with 22 mm in diameter. The resulting dose fall-off is slightly steeper (maximum difference of 5%) than the one generated by the P50 device with the 22 mm applicator. CONCLUSIONS A novel multichannel rectal applicator for contact radiotherapy with high-dose-rate 192Ir sources that can be integrated with commercially available treatment planning systems was designed to produce a dose distribution similar to the one obtained by the P50 device.
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Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - An-Sofie Verrijssen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel R Van den Bosch
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hélio Yoriyaz
- Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Silva MMRL, Junior SA, de Aguiar Pastore J, Santos ÉMM, de Oliveira Ferreira F, Spencer RMSB, Calsavara VF, Nakagawa WT, Lopes A. Late assessment of quality of life in patients with rectal carcinoma: comparison between sphincter preservation and definitive colostomy. Int J Colorectal Dis 2018; 33:1039-1045. [PMID: 29675592 PMCID: PMC6060835 DOI: 10.1007/s00384-018-3044-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Patients with cancer of the lower and middle rectum who are candidates for curative surgery often have negative opinions on definitive colostomy. The purpose of this study is to compare the quality of life (QoL) of patients who undergo standard treatment for rectal cancer with sphincter preservation or definitive colostomy. METHODS A total of 125 patients with adenocarcinoma of the lower or middle rectum who underwent radical surgery with curative intent with a follow-up ≥ 1 year were recruited: 83 patients (group 1) were subjected to low anterior resection and low colorectal or coloanal anastomosis-thus preserving their sphincter-and 42 (group 2) were treated with abdominoperineal resection, followed by terminal definitive colostomy. QoL was assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires. RESULTS Health and global quality of life were similar between groups; however, patients who underwent definitive colostomy had higher scores on the emotional (p value = 0.016) and cognitive function scales (p value = 0.017). Patients with sphincter preservation presented with more symptoms that were related to stool frequency (p value < 0.001), intestinal constipation (p value = 0.005), fecal incontinence (p value = 0.001), buttock pain (p value = 0.023), and nausea and vomiting (p value = 0.036), whereas patients with permanent colostomy had higher scores for dysuria (p value = 0.033). CONCLUSION Although global QoL scores did not differ between groups, patients who underwent definitive colostomy had significantly better functional and symptom scale scores, reflecting greater function with fewer symptoms.
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Affiliation(s)
- Mariane Messias Reis Lima Silva
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil.
| | - Samuel Aguiar Junior
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
| | - Juliana de Aguiar Pastore
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
| | - Érica Maria Monteiro Santos
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
| | - Fábio de Oliveira Ferreira
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
| | - Ranyell Matheus S B Spencer
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
| | - Vinicius F Calsavara
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
| | - Wilson Toshihiko Nakagawa
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
| | - Ademar Lopes
- Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil
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Comparison of Anthropometric Parameters after Ultralow Anterior Resection and Abdominoperineal Resection in Very Low-Lying Rectal Cancers. Gastroenterol Res Pract 2018; 2018:9274618. [PMID: 29983709 PMCID: PMC6015678 DOI: 10.1155/2018/9274618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/07/2018] [Accepted: 05/20/2018] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Ultralow anterior resection (uLAR) is a sphincter-saving procedure for very low-lying rectal cancers. This procedure, however, has complications related to defecation which can aggravate the patient's quality of life postoperatively. In this study, we compared the anthropometric and nutritional parameters after uLAR and abdominoperineal resection (APR). Methods We retrospectively reviewed the data of patients who underwent either uLAR or APR in 2012 for rectal cancers within 3 cm from the anal verge. Data including body weight, body mass index (BMI), levels of total protein, albumin, and hemoglobin and lymphocyte count were analyzed. We compared the changes of these parameters before operations to 3 years after discharge between uLAR and APR groups by ANOVA for repeated measures and Bonferroni comparison method. Results After 3 years of discharge, the body weight and BMI of the APR group were fully recovered to the preoperative levels; however, those of the uLAR group did not. The hemoglobin level in the APR group was recovered to the preoperative level within 3 months of discharge; however, that in the uLAR group was recovered after 1 year of discharge. Conclusions Recovery of anthropometric and nutritional status of patients was more stable after APR than after uLAR. These findings might indirectly reflect the low anterior syndrome effect of uLAR and help colorectal surgeons in selecting better surgical methods and in better counseling patients with very low-lying rectal cancer.
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Shiokawa H, Funahashi K, Kaneko H, Teramoto T. Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:29-34. [PMID: 31583297 PMCID: PMC6768681 DOI: 10.23922/jarc.2016-002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Abstract
Objectives: Intersphincteric resection (ISR) for low-lying rectal cancer (LRC) may induce major problems associated with anorectal function. In this study, we assessed the severity of ISR-induced impairment in anorectal function. Methods: In total, 45 patients followed up regularly ≥2 years after diverting ileostoma closure were eligible. The patients underwent ISR (n=35) or conventional coloanal anastomosis without resection of the internal anal sphincter (IAS) (n=10) for treatment of LRC from January 2000 to December 2011. We retrospectively compared anorectal function [stool frequency, urgency, Wexner incontinence scale (WIS) score, and patient satisfaction with bowel movement habits on a visual analog scale (VAS) score] for ≥2 years after stoma closure between the two groups. Results: The median follow-up period was 4.0 years (range, 2.0-6.5 years). Of the total, 17 (48.6%) patients who underwent ISR had poor anorectal function, including two with complete incontinence. Significant differences were found between the groups in the incidence of urgency (p=0.042), WIS score (p=0.024), and defecation disorder with a WIS score of ≥10 (p=0.034) but not in stool frequency. Based on the VAS score, 45.7% of patients who underwent ISR were dissatisfied with their bowel movement habits (p=0.041). Conclusions: Extensive resection of the IAS has negative short- and long-term effects on anorectal function.
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Affiliation(s)
- Hiroyuki Shiokawa
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, Tokyo, Japan
| | - Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, Tokyo, Japan
| | - Hironori Kaneko
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, Tokyo, Japan
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Trenti L, Galvez A, Biondo S, Solis A, Vallribera-Valls F, Espin-Basany E, Garcia-Granero A, Kreisler E. Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: A cross-sectional study. Eur J Surg Oncol 2018; 44:1031-1039. [PMID: 29665980 DOI: 10.1016/j.ejso.2018.03.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze the quality of life (QoL), low anterior resection syndrome (LARS) and fecal incontinence after surgery for mid to low rectal cancer and its relationship with the type of surgical procedure performed. METHODS A cross-sectional cohort survey study of 358 patients operated on for mid to low rectal cancer. Patients were included in three groups: abdominoperineal resection (APR), low mechanical colorectal anastomosis (CRA) and hand-sewn coloanal anastomosis (CAA). The QLQ-C30/CR29 questionnaires, LARS and Vaizey scores were used to study QoL and defecatory dysfunction. Multivariable analysis was used to estimate the prognostic effect of the variables on QoL and LARS scores. RESULTS 62.6% of the patients answered the survey. The global QoL score was similar among APR, CRA and CAA. Patients' body image perception was significantly worse after APR than after CRA or CAA. LARS score was better in CRA group (p = 0.002). A major LARS was observed in 83.3% of the patients who underwent CAA and in 56.6% of the patients who underwent CRA. No relationship between surgical procedures and the global QoL score was observed. Neoadjuvant radiotherapy (p = 0.048) and CAA (p = 0.005) were associated with a major LARS. The Vaizey score was higher for CAA than for CRA (p = 0.036). CONCLUSIONS Though CAA group presents worse LARS and higher faecal incontinence scores respect CRA patients, and APR is related with a worse body image, global QoL was similar in the three groups.
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Affiliation(s)
- Loris Trenti
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Ana Galvez
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain.
| | - Alejandro Solis
- Department of General and Digestive Surgery, Colorectal Unit Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Francesc Vallribera-Valls
- Department of General and Digestive Surgery, Colorectal Unit Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Eloy Espin-Basany
- Department of General and Digestive Surgery, Colorectal Unit Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Alvaro Garcia-Granero
- Department of General and Digestive Surgery, Colorectal Unit.Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Esther Kreisler
- Department of General and Digestive Surgery, Colorectal Unit.Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
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Couwenberg AM, Burbach JPM, van Grevenstein WMU, Smits AB, Consten ECJ, Schiphorst AHW, Wijffels NAT, Heikens JT, Intven MPW, Verkooijen HM. Effect of Neoadjuvant Therapy and Rectal Surgery on Health-related Quality of Life in Patients With Rectal Cancer During the First 2 Years After Diagnosis. Clin Colorectal Cancer 2018; 17:e499-e512. [PMID: 29678514 DOI: 10.1016/j.clcc.2018.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Rectal cancer surgery with neoadjuvant therapy is associated with substantial morbidity. The present study describes the course of quality of life (QOL) in rectal cancer patients in the first 2 years after the start of treatment. PATIENTS AND METHODS We performed a prospective study within a colorectal cancer cohort including rectal cancer patients who were referred for neoadjuvant chemoradiation or short-course radiotherapy and underwent rectal surgery. QOL was assessed using the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30) and colorectal cancer questionnaire (EORTC QLQ-CR29) before treatment and after 3, 6, 12, 18, and 24 months. The outcomes were compared with the QOL scores from the Dutch general population and stratified by low anterior resection and abdominoperineal resection. Postoperative bowel dysfunction after low anterior resection was measured using the low anterior resection syndrome score. RESULTS Of the 324 patients, 272 (84%) responded to at least 2 questionnaires and were included in the present study. Compared with pretreatment levels, the strongest decline was observed in physical, role, and social functioning at 3 and 6 months after the start of treatment. Global health and cognitive functioning declined to a lesser extend, and emotional functioning gradually improved over the time. Within 24 months, the QOL scores had recovered toward the pretreatment levels in most patients. Compared with the general population, physical, role, social, and cognitive functioning and symptoms of fatigue and insomnia remained significantly worse in patients on longer-term. After low anterior resection, major bowel dysfunction was reported by 44% to 60% of the patients. Increasing urinary incontinence and severe complaints of impotence were observed in patients who had undergone abdominoperineal resection. CONCLUSION Rectal cancer treatment is associated with a significant decline in QOL during the first 6 months after the diagnosis. Within 2 years, most patients return toward pretreatment functioning but could still experience poorer functioning and treatment-related symptoms compared with the general population. These findings support shared decision-making and emphasize the need for postoperative supportive care and novel treatment approaches.
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Affiliation(s)
- Alice M Couwenberg
- Department of Radiation-Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Johannes P M Burbach
- Department of Radiation-Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Anke B Smits
- Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Niels A T Wijffels
- Department of Surgery, Zuwe Hofpoort Ziekenhuis, Woerden, The Netherlands
| | - Joost T Heikens
- Department of Surgery, Ziekenhuis Rivierenland, Tiel, The Netherlands
| | - Martijn P W Intven
- Department of Radiation-Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; University of Utrecht, Utrecht, The Netherlands
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42
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Draeger TB, Aslam U, Mokraoui N, Seitelman E, Datta R, Amajoyi RC. Intersphincteric proctectomy for rectal mucocele in a Crohn's patient with anal stenosis. A case report and review of literature. Int J Surg Case Rep 2018; 44:148-151. [PMID: 29529537 PMCID: PMC5928289 DOI: 10.1016/j.ijscr.2017.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/05/2017] [Indexed: 12/02/2022] Open
Abstract
In patients who have undergone a colonic resection with creation of an end colostomy, drainage of mucus secreted by the mucosa of the rectal stump may not be possible if there is an outlet obstruction. With an outlet obstruction, formation of a rectal mucocele occurs. A rectal mucocele is a rare condition which has only been reported sporadically in case reports. We present here the utility of an intersphincteric proctectomy for treatment of a rectal mucocele in a 47 year old male Crohn's patient resulting in negligible post-operative or long-term morbidities.
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Affiliation(s)
- Tyler B Draeger
- South Nassau Communities Hospital, Department of Surgery, United States
| | - Usman Aslam
- New York Instituite of Technology, Collage of Osteopathic Medicine, United States
| | | | - Eric Seitelman
- South Nassau Communities Hospital, Department of Surgery, United States
| | - Rajiv Datta
- South Nassau Communities Hospital, Department of Surgery, United States
| | - Robert C Amajoyi
- South Nassau Communities Hospital, Department of Surgery, United States.
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43
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Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Laparoscopic Versus Conventional Open Surgery in Intersphincteric Resection for Low Rectal Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:189-200. [PMID: 29232537 DOI: 10.1089/lap.2017.0495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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44
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Ramage L, Mclean P, Simillis C, Qiu S, Kontovounisios C, Tan E, Tekkis P. Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer. Updates Surg 2018; 70:15-21. [PMID: 29313248 PMCID: PMC5866271 DOI: 10.1007/s13304-017-0507-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/02/2017] [Indexed: 12/15/2022]
Abstract
Adequate oncological outcomes have been demonstrated with rectal resection and handsewn coloanal anastomosis (CAA) in tumours in close proximity to the internal anal sphincter. Our aim was to assess functional differences between handsewn CAA and ultralow stapled anastomosis. Participants were identified from a single-surgeon series. Included participants underwent anorectal physiology testing of anal sphincter function, in addition to completion of several questionnaires: Wexner Incontinence Score (WIS); Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ); Low Anterior Resection Syndrome (LARS) Score; SF36. Non-parametric data compared using the Mann–Whitney U test. 20 participants were included; 11 stapled and 9 handsewn. Mean follow-up was 2.95 ± 1.97 years. The mean LARS score was 21.9 ± 1.97 years in the stapled group versus 29.4 ± 9.57 in the handsewn group (p = 0.133). The Wexner incontinence score was significantly higher in the handsewn group (p = 0.0076), with a mean score of 4.6 ± 3.69 versus 10.9 ± 4.76. The incontinence domain of the BBUSQ was also significantly worse in patients with a handsewn anastomosis (p = 0.001). With the exception of general health (p = 0.035) and social functioning (p = 0.035), which were worse in the handsewn groups, the other six domains of the SF-36 showed no statistical difference between groups. Anorectal physiology scores were not significantly different. Handsewn CAA anastomosis is known to be safe and oncologically feasible. Patient selection should be vigorous, with preoperative counseling regarding the likelihood of incontinence to manage patients’ expectations and promote comparable quality of life in the long-term.
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Affiliation(s)
- Lisa Ramage
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Paul Mclean
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Constantinos Simillis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Shengyang Qiu
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK. .,Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Emile Tan
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK.,Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Paris Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK.,Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
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45
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Chen H, Ma B, Gao P, Wang H, Song Y, Tong L, Li P, Wang Z. Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis. World J Surg Oncol 2017; 15:229. [PMID: 29282141 PMCID: PMC5745851 DOI: 10.1186/s12957-017-1304-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study was to compare the short-term and mid-term effects of laparoscopic intersphincteric resection with the conventional open approach for patients with low rectal cancer through a meta-analysis. METHODS The PubMed, EMBASE, Cochrane, and Ovid databases were searched for eligible studies until March 2017. Operation time, blood loss, circumferential resection margin-positive rate, distal margin length, number of resected lymph nodes, diverting stoma rate, postoperative overall morbidity, anastomotic leakage, and hospital stay were the main short-term effect endpoints. We also examined disease-free survival, overall survival, local recurrence, and post-operational anal function as secondary outcomes to evaluate the mid-term effects of laparoscopic surgery. RESULTS Five studies involving 620 patients were included in the analyses. Compared with the open approach, the laparoscopic ISR had less blood loss (weighted mean difference [WMD] = - 214.65 ml, 95% CI [- 370.44, - 196.13], p < 0.01), less postoperative overall morbidity (OR = 0.58, 95% CI [0.40, 0.86], p < 0.01), and shorter duration of hospital stay (WMD = - 5.87 days, 95% CI [- 11.35, - 0.40], p < 0.05); however, the operation time was significantly longer in the laparoscopic group (WMD = 47.34 min, 95% CI [4.10, 90.58], p < 0.05). No other significant differences were observed. CONCLUSION Laparoscopic ISR for low rectal cancer offers fewer complications and faster recovery, with similar operation quality and mid-term oncological results than the conventional approach. Although this technique is comparatively more complex than the conventional approach and requires practice, laparoscopic ISR shows great potential as a surgical option and deserves further clinical study.
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Affiliation(s)
- Hanyu Chen
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Bin Ma
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Peng Gao
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Hongchi Wang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Yongxi Song
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Linhao Tong
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Peiwen Li
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Zhenning Wang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
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46
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Zanguie M, Abdollahi A, Salek R, Jangjoo A, Jabbari Nooghabi M, Shabahang H, Golmohammadzadeh H. Three Anastomotic Techniques Following Laparoscopic Rectal Cancer Resection: Our Experience in 155 Patients. Surg Innov 2017; 25:57-61. [DOI: 10.1177/1553350617745976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Mahtab Zanguie
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roham Salek
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Jabbari Nooghabi
- Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Hosein Shabahang
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Golmohammadzadeh
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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47
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Zhang B, Ding JH. Functional outcomes after intersphincteric resection for ultralow rectal cancer. Shijie Huaren Xiaohua Zazhi 2017; 25:2761-2769. [DOI: 10.11569/wcjd.v25.i31.2761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Anal function is one of the most important parameters for evaluating the efficacy of intersphincteric resection (ISR) for the treatment of ultralow rectal cancer (< 1 cm from the anal sphincter). Although there have been no results hitherto from randomized controlled trials to verify the clinical benefits of the ultimate sphincter-sparing technique, increasing evidence demonstrates that ISR significantly decreases the rate of permanent stoma and patients could acquire satisfied functional results after surgery. This review discusses the short-term and long-term functional outcomes, risk factors for anal incontinence, and surgical method and approach of ISR.
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Affiliation(s)
- Bin Zhang
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing 100088, China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing 100088, China
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48
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Kinoshita Y, Ohkusa T, Izukura R, Chishaki A, Mibu R. Effects of chemotherapy on the health-related quality of life of Japanese lower rectal cancer patients after sphincter-saving surgery. J Psychosoc Oncol 2017; 35:468-482. [PMID: 28414629 DOI: 10.1080/07347332.2017.1320348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We examined the effects of adjuvant chemotherapy on the health-related quality of life (HRQOL) of lower rectal cancer patients receiving sphincter-saving surgery (SSS). In all, 109 patients completed a questionnaire before surgery and 1, 6, and 12 months afterwards. In the chemotherapy group, physical and social functioning scores were significantly lower 12 months after surgery compared with the nonchemotherapy group. These effects of adjuvant chemotherapy suggest that a different clinical approach might more effectively improve physical and social functioning in lower-rectal cancer patients undergoing chemotherapy. Healthcare providers should be alert for adverse events in patients with lower-rectal cancer and promptly address such conditions.
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Affiliation(s)
- Yumiko Kinoshita
- a Department of Health Sciences , Kyushu University , Fukuoka , Japan
| | - Tomoko Ohkusa
- b Department of Nursing , Ube Frontier University , Ube , Japan
| | - Rieko Izukura
- c Medical Information Center , Kyushu University Hospital , Fukuoka , Japan
| | - Akiko Chishaki
- a Department of Health Sciences , Kyushu University , Fukuoka , Japan
| | - Ryuichi Mibu
- a Department of Health Sciences , Kyushu University , Fukuoka , Japan.,d Department of Nursing , International University of Health and Welfare , Fukuoka , Japan
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49
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Clinical and functional results of laparoscopic intersphincteric resection for ultralow rectal cancer: is there a distinction between the three types of hand-sewn colo-anal anastomosis? Int J Colorectal Dis 2017; 32:587-590. [PMID: 27878621 DOI: 10.1007/s00384-016-2724-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to compare the clinical and functional outcomes of three types of hand-sewn colo-anal anastomosis (CAA) after laparoscopic intersphincteric resection (Lap-ISR) for patients with ultralow rectal cancer. METHODS A total of 79 consecutive patients treated by Lap-ISR for low-lying rectal cancer in an academic medical center from June 2011 to February 2016. According to the distal tumor margin and individualized anal length, the patients underwent three types of hand-sewn CAA including partial-ISR, subtotal-ISR, and total-ISR. RESULTS Of the 79 patients, 35.4% required partial-ISR, 43% adopted subtotal-ISR, and 21.5% underwent total-ISR. R0 resection was achieved in 78 patients (98.7%). In addition to distal resection margin, there were no significant differences in clinicopathological parameters and postoperative complications between the three groups. The type of hand-sewn CAA did not influence the 3-year disease-free survival (DFS) or local relapse-free survival (LFS). At 24-months follow-up, in spite of higher incontinence scores in total-ISR group, there were not statistically significant differences in functional outcomes including Wexner score or Kirwan grade between the groups. Nevertheless, patients with chronic anastomotic stricture showed worse anal function than those without the complication. CONCLUSION The type of hand-sewn CAA after Lap-ISR may not influence oncological and functional outcomes, but chronic stricture deteriorates continence status.
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50
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Liu LG, Yan XB, Shan ZZ, Yan LL, Jiang CY, Zhou J, Tian Y, Jin ZM. Anorectal functional outcome following laparoscopic low anterior resection for rectal cancer. Mol Clin Oncol 2017; 6:613-621. [PMID: 28413679 DOI: 10.3892/mco.2017.1183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/23/2017] [Indexed: 01/01/2023] Open
Abstract
Low anterior resection (LAR) with total mesorectal excision has been considered a standard treatment for patients with rectal cancer. However, the functional outcome and life quality of laparoscopic LAR (LLAR) in Chinese patients remain unclear. A cohort of 51 Chinese patients (22 men and 29 women) who had undergone LLAR was included in this study. Anorectal manometry combined with the Wexner scores questionnaire were applied to assess functional outcome preoperatively (1 week) and postoperatively (at 3, 6 and 9 months). The validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires were also used to assess the patients' quality of life at the indicated time points. The results demonstrated that the manometric parameters exhibited a temporary decrease at 3 months postoperatively, but a gradual increase at 6 and 9 months, while the Wexner scores exhibited an opposite trend. Furthermore, patients with high anastomoses had significantly higher manometric parameters, a lower frequency of incontinence and lower Wexner scores compared with those with low anastomoses at 9 months (all P<0.05). For the entire cohort, quality of life at 3 months postoperatively was worse compared with the preoperative level, but returned to normal by 9 months. Patients with high anastomoses exhibited significantly better role, emotional and social function, had a better body image and sexual function, fewer problems with defecation and lower frequency of diarrhea, as well as fewer chemotherapy-related side effects at 6 months postoperatively when compared with the low anastomosis group (all P<0.05). In conclusion, LLAR is generally acceptable for Chinese patients with rectal cancer, particularly for those with middle or high rectal cancer, in terms of functional outcome and quality of life.
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Affiliation(s)
- Li-Guo Liu
- Department of Surgery, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Xue-Bing Yan
- Department of Surgery, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Ze-Zhi Shan
- Department of Surgery, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Lei-Lei Yan
- Department of Surgery, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Chun-Yu Jiang
- Department of Radiology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Jia Zhou
- Department of Radiology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Yuan Tian
- Department of Surgery, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
| | - Zhi-Ming Jin
- Department of Surgery, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, P.R. China
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