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Rutegård M, Jutesten H, Buchwald P, Angenete E, Lydrup ML. Minor impact of anastomotic leakage in anterior resection for rectal cancer on long-term male urinary and sexual function. Int J Colorectal Dis 2024; 39:49. [PMID: 38589520 PMCID: PMC11001750 DOI: 10.1007/s00384-024-04626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Anastomotic leakage after anterior resection for rectal cancer induces bowel dysfunction, but the influence on urinary and sexual function is largely unknown. This cross-sectional cohort study evaluated long-term effect of anastomotic leakage on urinary and sexual function in male patients. METHODS Patients operated with anterior resection for rectal cancer in 15 Swedish hospitals 2007-2013 were identified. Anastomotic leakage and other clinical variables were retrieved from the Swedish Colorectal Cancer Registry and medical records. Urinary and sexual dysfunction were evaluated at 4 to 11 years after surgery using the International Prostate Symptom Score, International Index of Erectile Function, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire CR29. The effect of anastomotic leakage on average scores of urinary and sexual dysfunction was evaluated as a primary outcome, and the single items permanent urinary catheter and sexual inactivity as secondary outcomes. The association of anastomotic leakage and functional outcomes was analyzed using regression models with adjustment for confounders. RESULTS After a median follow-up of 84 months (interquartile range: 67-110), 379 out of 864 eligible men were included. Fifty-nine (16%) patients had anastomotic leakage. Urinary incontinence was more common in the leakage group, with an adjusted mean score difference measured by EORTC QLQ ColoRectal-29 of 8.69 (95% confidence interval: 0.72-16.67). The higher risks of urinary frequency, permanent urinary catheter, and sexual inactivity did not reach significance. CONCLUSION Anastomotic leakage after anterior resection had a minor negative impact on urinary and sexual function in men.
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Affiliation(s)
- Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Henrik Jutesten
- Department of Surgery, Institution for Clinical Sciences Malmö, Lund University, Skåne University Hospital Malmö, Carl-Bertil Laurells Gata 9, 205 02, Malmö, Sweden
| | - Pamela Buchwald
- Department of Surgery, Institution for Clinical Sciences Malmö, Lund University, Skåne University Hospital Malmö, Carl-Bertil Laurells Gata 9, 205 02, Malmö, Sweden
| | - Eva Angenete
- Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Östra, Region Västra Götaland, Gothenburg, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Institution for Clinical Sciences Malmö, Lund University, Skåne University Hospital Malmö, Carl-Bertil Laurells Gata 9, 205 02, Malmö, Sweden.
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Kim H, Kim H, Cho OH. Bowel dysfunction and lower urinary tract symptoms on quality of life after sphincter-preserving surgery for rectal cancer: A cross-sectional study. Eur J Oncol Nurs 2024; 69:102524. [PMID: 38382154 DOI: 10.1016/j.ejon.2024.102524] [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: 11/25/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES This study aimed to investigate the impact of bowel dysfunction and lower urinary tract symptoms on the quality of patients with rectal cancer who underwent sphincter-preserving surgery. METHODS This cross-sectional study included patients who were followed up after sphincter-preserving surgery in Korea. Data were collected from May 2022 to February 2023. The participants (n = 110) responded to self-reported questionnaires assessing the Low Anterior Resection Syndrome (LARS) score, International Prostate Symptom Score (IPSS), European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-C29 questionnaires. RESULTS Among the participants, 66.4% had major low anterior resection syndrome, and 39.1% had moderate-to-severe lower urinary tract symptoms. Patients with higher severity of low anterior resection syndrome and lower urinary tract symptoms had a lower quality of life. The IPSS, performance status, duration since the end of the surgery, comorbidities, LARS scores, and tumor location on the anal verge negatively affected the quality of life. CONCLUSION Patients with more severe bowel dysfunction or lower urinary tract symptoms have a poorer quality of life. Nurses should be made aware of the factors that can reduce the quality of life of patients who have undergone sphincter-preserving surgery. Accordingly, they should plan to address the various nursing problems.
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Affiliation(s)
- Hyekyung Kim
- Department of Nursing, Catholic Kwandong University, Gangneung, Republic of Korea.
| | - Hyedan Kim
- Advanced Practice Nurse, Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea.
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Tang B, Zhou S, He K, Mei S, Qiu W, Guan X, Liu F, Chi C, Wang X, Tian J, Liu Q, Tang J. Applications of Near-Infrared Fluorescence Imaging and Angiography of Inferior Vesical Artery in Laparoscopic Lateral Lymph Node Dissection: A Prospective Nonrandomized Controlled Study. Dis Colon Rectum 2024; 67:175-184. [PMID: 38091416 DOI: 10.1097/dcr.0000000000002926] [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: 12/18/2023]
Abstract
BACKGROUND Near-infrared imaging with indocyanine green has been used to guide lateral lymph node dissection, yet its efficacy and benefits need further investigation. OBJECTIVE To investigate the efficacy and feasibility of near-infrared fluorescence imaging and angiography of the inferior vesical artery in laparoscopic lateral lymph node dissection. DESIGN A prospective nonrandomized controlled study. SETTINGS Single-center study. PATIENTS Patients with lower rectal cancer who underwent total mesorectal excision plus lateral lymph node dissection. MAIN OUTCOME MEASURES A cohort of 108 patients was enrolled. After propensity score matching, 29 patients in the near-infrared group and 50 patients in the non-near-infrared group were matched. The total number of harvested lateral lymph nodes, positive lateral lymph nodes, inferior vesical artery preservation, and postoperative urinary function were compared. RESULTS After propensity score matching, both groups had similar baseline characteristics. The total number of harvested lateral lymph nodes in the near-infrared group was significantly higher (12 vs 9, p = 0.013), but positive lateral lymph nodes were similar between the 2 groups (1 vs 1, p = 0.439). The inferior vesical artery preservation ratio was significantly increased with the aid of indocyanine green angiography (93.1% vs 56.0%, p < 0.001). The non-near-infrared group required more days for urinary catheter removal than the near-infrared group (5 vs 4, p = 0.046). Urinary recatheterization tended to occur more frequently in the non-near-infrared group, with a marginally significant trend (16% vs 0%, p = 0.059). The non-near-infrared group tended to have more cases with residual urine volume ≥50 mL than the near-infrared group (20.0% vs 3.4%, p = 0.087), especially in the bilateral dissection subgroup (41.2% vs 0%, p = 0.041). LIMITATIONS Small sample size. CONCLUSIONS Near-infrared imaging increased the number of harvested lateral lymph nodes, whereas real-time indocyanine green fluorescence angiography ensured the preservation of the inferior vesical artery and tended to improve postoperative urinary function.
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Affiliation(s)
- Bin Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sicheng Zhou
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Kunshan He
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenlong Qiu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fucheng Liu
- Department of General Surgery, Fengtai Hospital, Beijing, China
| | - Chongwei Chi
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Tian
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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de Carvalho MDSR, Pellino G, Pereira AMG, Bray-Beraldo F, Lopes RGC, Di Saverio S. Prevalence of urinary dysfunction after minimally invasive surgery for deep rectosigmoid endometriosis. Langenbecks Arch Surg 2023; 408:83. [PMID: 36773124 DOI: 10.1007/s00423-023-02831-6] [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: 07/15/2022] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE This study aimed to assess the prevalence and progression of lower urinary tract symptoms following laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid and identify preoperative factors associated with worse postoperative outcomes. METHODS Prospective, observational study. SETTINGS single-center, referral hospital for endometriosis. Patients undergoing laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid colon between October 2016 and October 2018. MAIN OUTCOME MEASURES urinary function was assessed with the validated Portuguese language version of the International Prostate Symptom Score, which is also used in women. The score was collected before and after surgery. The Wilcoxon signed-rank test was used to compare pre and postoperative scores and the chi-square test compared symptoms categorized by severity. RESULTS Fifty-three patients were assessed and 44 were included. Concerning urinary symptoms after surgery, the irritative symptoms prevailed over the obstructive ones. Additionally, 58.8% and 54.5% of the women reported moderate or severe symptoms at pre and postoperative, respectively. In at least one questionnaire category, the postoperative questionnaire scores increased in ten (22.7%) participants. A statistically significant difference was found comparing the changes from absent/mild to moderate/severe IPSS categories (P = 0.039). No significant changes were identified in any of the International Prostate Symptom Score pre and postoperatively (P = 0.876). CONCLUSIONS There was a high prevalence of pre and postoperative urinary symptoms. Patients with preoperative moderate/severe International Prostate Symptom Score are at risk of persisting urinary dysfunction after surgery for rectosigmoid deep endometriosis.
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Affiliation(s)
- Mariana de Sousa Ribeiro de Carvalho
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Studi della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Ana Maria Gomes Pereira
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil
| | - Fernando Bray-Beraldo
- Department of Digestive Surgery and Coloproctology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Reginaldo Guedes Coelho Lopes
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil
| | - Salomone Di Saverio
- Cambridge Endometriosis & Endoscopic Surgery Unit (CEESU) and Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy
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Li X, Fu R, Ni H, Du N, Wei M, Zhang M, Shi Y, He Y, Du L. Effect of Neoadjuvant Therapy on the Functional Outcome of Patients With Rectal Cancer: A Systematic Review and Meta-Analysis. Clin Oncol (R Coll Radiol) 2023; 35:e121-e134. [PMID: 35940977 DOI: 10.1016/j.clon.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/12/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
AIMS The impact of neoadjuvant therapy on the functional outcome of patients with resectable rectal cancer is still controversial. The aim of the present study was to explore the effects of neoadjuvant therapy on anorectal function (ARF), urinary function and sexual function in relevant patients. MATERIALS AND METHODS PubMed, Embase, Web of Science and the Cochrane Library were searched systematically. All English-language studies, published from January 2000 to July 2021, that explored the (postoperative) effects of neoadjuvant therapy versus upfront surgery on ARF, urinary function and sexual function of patients were included (PROSPERO 2021: CRD42021281617). RESULTS The data in this study were derived from 37 articles based on 33 studies; in total, 17 917 patients were enrolled. The meta-analysis revealed that the incidence of anorectal dysfunction in the neoadjuvant therapy group was significantly higher than that in the group of upfront surgery, which was manifested by a higher incidence of major low anterior resection syndrome (odds ratio = 3.09, 95% confidence interval = 2.48, 3.84; P < 0.001), reduction of mean squeeze pressure and mean resting pressure, and other manifestations, including clustering of stools, incontinence, urgency and use of pads. With the extension of follow-up time, the adverse effects of neoadjuvant therapy on major low anterior resection syndrome existed. Compared with patients undergoing upfront surgery, neoadjuvant therapy increased the risk of urinary incontinence (odds ratio = 1.31, 95% confidence interval = 1.00, 1.72; P = 0.05) and erectile dysfunction (odds ratio = 1.77, 95% confidence interval = 1.27, 2.45; P < 0.001). CONCLUSION Compared with upfront surgery, neoadjuvant therapy is not only associated with impairment of ARF, but also with increased incidence of urinary incontinence and male erectile dysfunction. However, the influence of confounding factors (e.g. surgical method, tumour stage) needs to be considered.
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Affiliation(s)
- Xiangyuan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haixiang Ni
- The Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Nannan Du
- Laboratory of Cell Engineering, Institute of Biotechnology, Beijing, China
| | - Mengfei Wei
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liwen Du
- Emergency Department, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
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