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Aktaş D, Koçaşlı S, Baykara ZG. The Effect of Pelvic Floor Muscle Exercises on Bowel Evacuation and Quality of Life in Following Intestinal Ostomy Closure: Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2024; 51:221-234. [PMID: 38820220 DOI: 10.1097/won.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
PURPOSE This purpose of this study was to evaluate the effect of pelvic floor muscle exercises (PFMEs) on bowel evacuation problems and health-related quality of life (HRQOL) following ostomy closure. DESIGN Randomized controlled trial. SUBJECTS AND SETTING Forty individuals following ostomy closure consented to participate in the study; 6 participants (15%) did not complete the trial (2 died and 2 required a second ostomy) yielding a study sample of 34. Participants were randomly allocated to an Exercise Group (EG, n = 17) and Control Group (CG, n = 17). The mean age of the EG was 55.7 (SD 12.6) years, whereas the mean age of the CG was 62.0 (SD 12.1) years. The study setting was the surgery clinic of 4 hospitals in Ankara, Turkey. Data were collected between December 2018 and May 2020. METHODS The study intervention, PFME training by a clinician, was administered to participants in the EG; CG participants received no information regarding PFME. Data were collected during face-to-face interviews on the day before discharge and by phone at the first, second, third, and sixth months after surgery. A questionnaire was used for data collection that queried a demographic and pertinent clinical questions, along with the Assessment Form for Bowel Evacuation Habits and Psychosocial Problems, Wexner Scale, and the Short Form (SF-36) Health-related Quality of Life Scale. Descriptive statistics and Mann-Whitney U test, t-test, Pearson-χ2 test, Fisher's Exact test, Friedman test, and Cochran-Q test statistical analysis according to normal distribution were used in data evaluation. RESULTS The number of defecations in the EG was statistically significantly lower than the CG at the second, third, and sixth months (P = .002, P = .002, P = .001, respectively). In addition, the number of individuals experiencing night defecation was statistically significantly less in the EG compared to the CG at the second-, third-, and sixth-month follow-ups (P = .001, P = .001, P = .028, respectively). HRQOL scores were also significantly higher in the EG. CONCLUSION Pelvic floor exercises applied after ostomy closure are effective in reducing bowel evacuation and increasing quality of life. Given these findings, PFMEs are recommended for patients after ostomy closure.
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Affiliation(s)
- Dilek Aktaş
- Dilek Aktaş , PhD, Faculty of Health Sciences, Department of Nursing School of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Sema Koçaşlı, PhD, Faculty of Health Sciences, Department of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Zehra Göçmen Baykara, PhD, Faculty of Nursing, Fundamentals of Nursing Department, Gazi University, Ankara, Turkey
| | - Sema Koçaşlı
- Dilek Aktaş , PhD, Faculty of Health Sciences, Department of Nursing School of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Sema Koçaşlı, PhD, Faculty of Health Sciences, Department of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Zehra Göçmen Baykara, PhD, Faculty of Nursing, Fundamentals of Nursing Department, Gazi University, Ankara, Turkey
| | - Zehra Göçmen Baykara
- Dilek Aktaş , PhD, Faculty of Health Sciences, Department of Nursing School of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Sema Koçaşlı, PhD, Faculty of Health Sciences, Department of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Zehra Göçmen Baykara, PhD, Faculty of Nursing, Fundamentals of Nursing Department, Gazi University, Ankara, Turkey
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Homma Y, Mimura T, Koinuma K, Horie H, Lefor AK, Sata N. Low anterior resection syndrome: Incidence and association with quality of life. Ann Gastroenterol Surg 2024; 8:114-123. [PMID: 38250691 PMCID: PMC10797839 DOI: 10.1002/ags3.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 01/23/2024] Open
Abstract
Aim Low anterior resection syndrome (LARS) causes devastating symptoms and impairs quality of life (QOL). Although its incidence and risk factors have been reported, these data are scarce in Japan. This study aimed to elucidate the incidence and risk factors of LARS as well as to evaluate its association with QOL in Japanese patients. Method Patients with anal defecation at the time of the survey between November 2020 and April 2021 were included, among those who underwent anus-preserving surgery for rectal tumors between 2014 and 2019 in tertiary referral university hospital. The severity of LARS and QOL were evaluated with the LARS score and the Japanese version of the fecal incontinence quality of life scale (JFIQL), respectively. Primary endpoint was the incidence of major LARS. Secondary endpoints were risk factors and association with JFIQL. Results Of 332 eligible patients, 238 (71.7%) answered the LARS survey completely. The incidence of major LARS was 22% overall, and 48% when limited to lower tumors. Independent risk factors included lower tumors (OR: 7.0, 95% CI: 2.1-23.1, p = 0.001) and surgical procedures with lower anastomoses (OR: 4.6, 95% CI: 1.2-18.5, p = 0.03). The JFIQL generic score correlated moderately with the LARS score (correlation coefficient of -0.65). The JFIQL generic score was also significantly lower in lower tumors. Conclusions The incidence of major LARS is 22% in Japanese patients, and independent risk factors include lower tumors and surgical procedures with lower anastomoses. More severe LARS is associated with worse QOL which is significantly more impaired in patients with lower tumors.
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Affiliation(s)
- Yuko Homma
- Department of Surgery, Division of Gastroenterological, General and Transplant SurgeryJichi Medical UniversityTochigiJapan
| | - Toshiki Mimura
- Department of Surgery, Division of Gastroenterological, General and Transplant SurgeryJichi Medical UniversityTochigiJapan
| | - Koji Koinuma
- Department of Surgery, Division of Gastroenterological, General and Transplant SurgeryJichi Medical UniversityTochigiJapan
| | - Hisanaga Horie
- Department of Surgery, Division of Gastroenterological, General and Transplant SurgeryJichi Medical UniversityTochigiJapan
| | - Alan Kawarai Lefor
- Department of Surgery, Division of Gastroenterological, General and Transplant SurgeryJichi Medical UniversityTochigiJapan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant SurgeryJichi Medical UniversityTochigiJapan
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Rooney MK, De B, Corrigan K, Smith GL, Taniguchi C, Minsky BD, Ludmir EB, Koay EJ, Das P, Koong AC, Peacock O, Chang G, You YN, Morris VK, Nogueras-González G, Holliday EB. Patient-reported Bowel Function and Bowel-related Quality of Life After Pelvic Radiation for Rectal Adenocarcinoma: The Impact of Radiation Fractionation and Surgical Resection. Clin Colorectal Cancer 2023; 22:211-221. [PMID: 36878805 PMCID: PMC10213111 DOI: 10.1016/j.clcc.2023.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Multimodality treatment for locally advanced rectal cancer (LARC) can include long-course radiotherapy (LCRT) or short course radiotherapy (SCRT). Nonoperative management is increasingly pursued for those achieving a complete clinical response. Data regarding long-term function and quality-of-life (QOL) are limited. METHODS Patients with LARC treated with radiotherapy from 2016 to 2020 completed the Functional Assessment of Cancer Therapy- General (FACT-G7), the Low Anterior Resection Syndrome Score (LARS) and the Fecal Incontinence QOL Scale (FIQOL). Univariate and multivariable linear regression analyses identified associations between clinical variables including radiation fractionation and the use of surgery versus non-operative management. RESULTS Of 204 patients surveyed, 124 (60.8%) responded. Median (interquartile range) time from radiation to survey completion was 30.1 (18.3-43) months. Seventy-nine (63.7%) respondents received LCRT, and 45 (36.3%) received SCRT; 101 (81.5%) respondents underwent surgery, and 23 (18.5%) pursued nonoperative management. There were no differences in LARS, FIQoL or FACT-G7 between patients receiving LCRT versus SCRT. On multivariable analysis, only nonoperative management was associated with lower LARS score signifying less bowel dysfunction. Nonoperative management and female sex were associated with a higher FIQoL score signifying less disruption and distress from fecal incontinence issues. Finally, lower BMI at the time of radiation, female sex, and higher FIQoL score were associated with higher FACT-G7 scores signifying better overall QOL. CONCLUSIONS These results suggest long-term patient-reported bowel function and QOL may be similar for individuals receiving SCRT and LCRT for the treatment of LARC, but nonoperative management may lead to improved bowel function and QOL.
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Affiliation(s)
- Michael K Rooney
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian De
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelsey Corrigan
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cullen Taniguchi
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bruce D Minsky
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ethan B Ludmir
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eugene J Koay
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Prajnan Das
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Albert C Koong
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Oliver Peacock
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - George Chang
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y Nancy You
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Emma B Holliday
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Sjövall A, Lagergren P, Johar A, Buchli C. Quality of life and patient reported symptoms after colorectal cancer in a Swedish population. Colorectal Dis 2023; 25:191-201. [PMID: 36097801 DOI: 10.1111/codi.16332] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 02/08/2023]
Abstract
AIM A proportion of patients treated for colorectal cancer have impaired quality of life (QoL) but it is uncertain if the level of QoL differs from the corresponding background population. This population-based cohort study aimed to evaluate health-related QoL in colorectal cancer patients and compare their QoL with that of a Swedish reference population. METHODS Patients who underwent surgery for colorectal cancer Stages I-III in the Stockholm-Gotland region in 2013-2015 received the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the QLQ-CR29 questionnaires and the low anterior resection syndrome score, 1 year after surgery. Patient and tumour data were collected from the Swedish Colorectal Cancer Registry. The patient cohort was matched to a Swedish reference population regarding EORTC QLQ-C30. Global QoL was compared to the reference population and a patient group with impaired QoL was defined. Detailed patient-reported outcomes were analysed in relation to global QoL in the patient cohort. RESULTS A total of 925 patients returned the questionnaires and 358 patients (38.70%) reported a clinically relevant impaired global QoL compared to the reference population. Patients with impaired QoL reported clinically relevant and statistically significantly more complaints regarding bowel habits, pain and anxiety. After adjustment for sex, age and stoma, anxiety was the strongest predictor for impaired QoL, with OR 6.797 (95% CI 4.677-9.879). CONCLUSION A substantial proportion of patients treated for colorectal cancer have impaired global QoL. This impairment is strongly associated with several physical symptoms and anxiety.
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Affiliation(s)
- Annika Sjövall
- Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Christian Buchli
- Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Barisic G, Andjelkov K, Rosic J, Miladinov M, Kotur-Stеvuljevic J, Dinic T, Jelenkovic J, Krivokapic Z. Application of nanofat for treatment of traumatic faecal incontinence after sphincteroplasty - A pilot study. Colorectal Dis 2022; 24:1054-1062. [PMID: 35426481 DOI: 10.1111/codi.16148] [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: 01/18/2022] [Revised: 03/14/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to investigate whether the application of nanofat containing stem cells improves continence in women who had previously undergone anal sphincteroplasty with unsatisfactory long-term outcomes. METHOD This prospective pilot study included nine women with various degrees of anal incontinence who had previously undergone anal sphincteroplasty due to obstetric trauma. In all patients, the Wexner Incontinence Score (WS) and Faecal Incontinence Quality of Life Score (FIQLS), as well as anal manometry and endoanal ultrasound measurements, were performed before the procedure and during follow-up. In all patients, liposuction was performed and 50 ml of raw lipoaspirate was obtained and processed using a NanoFat Kit device. Approximately 20 ml of the mechanically emulsified and filtrated fat was obtained and the anal sphincter complex was infiltrated with it. Patient follow-up was conducted in person or via telephone 6 and 12 months after the procedure. RESULTS The squeeze pressure was significantly increased 6 months after the procedure (p = 0.01). The external anal sphincter measured at the 12 o'clock position was significantly thicker (p = 0.04). A significant decrease in the WS was observed both 6 and 12 months after the procedure compared with baseline values (p < 0.05 for both). CONCLUSION This study is the first to show that the application of nanofat as an injectable product improves continence in patients with unsatisfactory results after sphincteroplasty, suggesting it to be a promising and effective therapeutic tool. The procedure is safe and can be easily performed as an ambulatory procedure.
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Affiliation(s)
- Goran Barisic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Digestive Surgery - First Surgical Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Jovana Rosic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Miladinov
- Clinic for Digestive Surgery - First Surgical Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Tanja Dinic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelenko Jelenkovic
- COVID Hospital Batajnica, University Clinical Center of Serbia, Belgrade, Serbia
| | - Zoran Krivokapic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Digestive Surgery - First Surgical Clinic, University Clinical Center of Serbia, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
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Al Rashid F, Liberman AS, Charlebois P, Stein B, Feldman LS, Fiore JF, Lee L. The impact of bowel dysfunction on health-related quality of life after rectal cancer surgery: a systematic review. Tech Coloproctol 2022; 26:515-527. [PMID: 35239096 DOI: 10.1007/s10151-022-02594-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Symptoms of bowel dysfunction after sphincter-preserving rectal cancer surgery have an important impact on health-related quality of life (HRQOL), but that relationship is complex. A better understanding of this relationship allows for better informed shared decision-making about surgery. Our objective was to perform a systematic review to determine which HRQOL domains are most affected by postoperative bowel dysfunction. METHODS A systematic review of the CINAHL, Cochrane Library, Embase, Medline, PsycInfo, PubMed, Web of Science, and Scopus databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies that evaluated bowel function after sphincter-preserving rectal cancer surgery and assessed HRQOL using a validated instrument. The quality of HRQOL analysis was assessed using an 11-item checklist. The main outcome was the impact bowel dysfunction had on global and domain specific quality-of-life indices. The impact was evaluated for clinical relevance using the Minimum Clinical Important Difference (MCID) for each specific HRQOL instrument. RESULTS Out of 952 unique citations, 103 studies were full-text reviews. Eighteen studies met the inclusion criteria (4 prospective cohorts and 9 cross-sectional studies). Of the 15 studies with long-term follow-up, the time to assessment after surgery ranged from 1.2 to 14.6 years. The low anterior resection syndrome score and European Organization for Research and Treatment core quality-of-life questionnaire (EORTC QLQ-C30) were the most commonly used instruments. Medium and large magnitudes in MCID were seen for global health, social functioning, emotional functioning, fatigue, diarrhea, and financial difficulties. Among included studies, the most consistently reported functional domains affected by bowel function were social functioning and emotional functioning. CONCLUSIONS Following sphincter-preserving rectal cancer surgery, poor bowel function mainly affects the social and emotional functional domains of HRQOL, which in turn impact global scores. This finding can help inform patients about expected changes in HRQOL after rectal cancer surgery and facilitate individualized treatment decisions.
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Affiliation(s)
- F Al Rashid
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada.
| | - A S Liberman
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - P Charlebois
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - B Stein
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - L S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - J F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - L Lee
- Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
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Low Anterior Resection Syndrome in Adults with Rectal Cancer in China: a Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractLow anterior resection syndrome (LARS) comprises a collection of symptoms affecting patients’ defecation after restorative surgery for rectal cancer. The aim of this work was to study the incidence and risk factors for LARS in China. Rectal cancer patients undergoing total mesorectal excision and colorectal anastomosis between May 2012 and January 2015 were identified from a single center. The patients completed the LARS score questionnaire through telephone. The clinical and pathological factors that may influence the occurrence of LARS were analyzed using univariate and multivariate logistic regression analysis. The influence of postoperative recovery time and pelvic dimensions on the occurrence of LARS was also analyzed. This study included 337 patients, at an average age of 61.03 SD11.32. The mean LARS score of the patients was 14.08 (range 0–41). A total of 126 patients (37.4%) developed LARS after surgery, including 63 (18.7%) severe cases. Compared with the scores within the initial 6 postoperative months, the LARS scores of the patients in 6~18 months after the surgery showed significant reductions (p < 0.01). In multivariate analysis, lower locations of anastomosis, pre-surgery radiotherapy, and shorter postoperative recovery time were significant predisposing factors for LARS. A subgroup analysis revealed that patients suffering from LARS over 18 months after surgery were found to have a significantly shorter interspinous distance than those without LARS (p < 0.05). LARS could improve over time after surgery. Lower anastomotic level and pre-surgery radiotherapy are risk factors for LARS.
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Burch J, Taylor C, Wilson A, Norton C. Symptoms affecting quality of life after sphincter-saving rectal cancer surgery: A systematic review. Eur J Oncol Nurs 2021; 52:101934. [PMID: 33845303 DOI: 10.1016/j.ejon.2021.101934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Rectal cancer is common and is frequently treated with surgery which removes the rectum but retains anal sphincters. After sphincter-saving rectal cancer surgery, which can result in a reduced rectal storage capacity and nerve damage, symptoms frequently occur. METHOD A systematic review was undertaken to determine which symptoms occur and their effect on quality of life. Data from questionnaires and interviews were analysed thematically. RESULTS Fourteen heterogeneous studies were identified reporting both qualitative and quantitative data on over 1700 individuals. The most commonly reported symptoms related to bowel changes. The most problematic changes were bowel and sexual dysfunction. Quality of life was most affected by an inability to function as individuals desired, specifically in their chosen role and socially. Quality of life improved as time progressed or symptoms resolved; but symptoms could persist for many years. CONCLUSION After sphincter-saving rectal cancer surgery quality of life is affected by symptoms such as bowel dysfunction. Healthcare professionals need to gain a better understanding of which symptoms most bother individuals to enable patient-focussed interventions to be planned and improve quality of life.
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Affiliation(s)
- Jennie Burch
- St Mark's Hospital, Part of London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
| | - Claire Taylor
- St Mark's Hospital, Part of London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - Ana Wilson
- St Mark's Hospital, Part of London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex, HA1 3UJ, UK; Imperial College, London, UK
| | - Christine Norton
- Kings College London, James Clerk Maxwell Building, 57 Waterloo Road, Lambeth, London, SE1 8WA, UK
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9
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Głowacka-Mrotek I, Tarkowska M, Nowikiewicz T, Jankowski M, Mackiewicz-Milewska M, Hagner W, Zegarski W. Prospective evaluation of the quality of life of patients undergoing surgery for colorectal cancer depending on the surgical technique. Int J Colorectal Dis 2019; 34:1601-1610. [PMID: 31396708 DOI: 10.1007/s00384-019-03357-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Monitoring of the quality of life of patients in addition to satisfactory survival indexes in order to choose an optimal treatment method is a trend in contemporary oncological surgery. The goal of the study was to prospectively evaluate the quality of life of patients treated for colorectal cancer depending on the type of surgical technique (open surgery (OS) vs. laparoscopic surgery (LS)). METHODS The quality of life was evaluated thrice in the study groups (on the day of admission to the ward (I), 6 months (II), and 18 months after the procedure (III)). The following questionnaires were used in this evaluation: QLQ-C30 European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, QLQ-CR29 Quality of Life Questionnaire (module-colorectal cancer), and Acceptance of Illness Scale (AIS). RESULTS Sixty-seven patients completed this prospective clinical cohort study (LS-32; OS-35). The QLQ-C30 questionnaire demonstrated improvement in functional scales among patients treated with LS technique (p < 0.05) as well as with regard to overall quality of life 6 months after surgery (p < 0,001), while at 18 months postsurgery, statistically significant differences were noted for physical function (p = 0.001) and overall quality of life (p < 0.0001). AIS scale analysis demonstrated that patients treated with laparoscopy were characterized by better acceptance of illness (p < 0.05). Statistically significant differences between OS and LS groups were noted based on the QLQ-CR29 questionnaire with regard to the following scales: body image (p = 0.041) and body mass problem (p = 0.024)-patients treated with LS technique had better scores. CONCLUSIONS Laparoscopic surgery gives patients a chance for better quality of life.
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Affiliation(s)
- Iwona Głowacka-Mrotek
- Chair and Department of Rehabilitation, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094, Bydgoszcz, Poland.
| | - Magdalena Tarkowska
- Department of Laser Therapy and Physiotherapy, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Tomasz Nowikiewicz
- Chair and Department of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Oncology Centre - Prof. Franciszek Łukaszczyk Memorial Hospital in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Michał Jankowski
- Department of Laser Therapy and Physiotherapy, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Magdalena Mackiewicz-Milewska
- Chair and Department of Rehabilitation, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094, Bydgoszcz, Poland
| | - Wojciech Hagner
- Chair and Department of Rehabilitation, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Department of Laser Therapy and Physiotherapy, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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10
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Buchli C, Martling A, Sjövall A. Low anterior resection syndrome after right- and left-sided resections for colonic cancer. BJS Open 2018; 3:387-394. [PMID: 31183455 PMCID: PMC6551391 DOI: 10.1002/bjs5.50128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/07/2018] [Indexed: 01/11/2023] Open
Abstract
Background This population‐based cohort study aimed to evaluate occurrence of low anterior resection syndrome (LARS) and correlate this to health‐related quality of life in patients who had undergone segmental colonic resection for colonic cancer in the Stockholm–Gotland region. The hypothesis was that there is a difference in occurrence of LARS depending on whether a right‐ or a left‐sided resection was performed. Methods Patients who underwent segmental colonic resection for colonic cancer stages I–III in the Stockholm–Gotland region in 2013–2015 received EORTC QLQ‐C30, QLQ‐CR29 and LARS score questionnaires 1 year after surgery. Clinical patient and tumour data were collected from the Swedish ColoRectal Cancer Registry. Patient‐reported outcome measures were analysed in relation to type of colonic resection. Results Questionnaires were sent to 866 patients and complete responses were provided by 517 (59·7 per cent). After right‐sided resection 20·6 per cent reported major LARS. After left‐sided resection the proportion with major LARS was 15·6 per cent. The odds ratio (OR) for major LARS after right‐sided resection was 1·45 (95 per cent c.i. 1·02 to 2·06; P = 0·037) compared with left‐sided resection. After adjustment for age and sex, an increase in the risk of major LARS after right‐ versus left‐sided resection remained (OR 1·48, 1·03 to 2·13; P = 0·035). Major LARS correlated with impaired quality of life. Conclusion Major LARS was more frequent after right‐sided than following left‐sided colonic resection. Major LARS reflected impaired quality of life.
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Affiliation(s)
- C Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Centre of Digestive Diseases Karolinska University Hospital Stockholm Sweden
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Centre of Digestive Diseases Karolinska University Hospital Stockholm Sweden
| | - A Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Centre of Digestive Diseases Karolinska University Hospital Stockholm Sweden
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11
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Trybek P, Nowakowski M, Salowka J, Spiechowicz J, Machura L. Sample Entropy of sEMG Signals at Different Stages of Rectal Cancer Treatment. ENTROPY (BASEL, SWITZERLAND) 2018; 20:E863. [PMID: 33266587 PMCID: PMC7512423 DOI: 10.3390/e20110863] [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: 10/11/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/13/2022]
Abstract
Information theory provides a spectrum of nonlinear methods capable of grasping an internal structure of a signal together with an insight into its complex nature. In this work, we discuss the usefulness of the selected entropy techniques for a description of the information carried by the surface electromyography signals during colorectal cancer treatment. The electrical activity of the external anal sphincter can serve as a potential source of knowledge of the actual state of the patient who underwent a common surgery for rectal cancer in the form of anterior or lower anterior resection. The calculation of Sample entropy parameters has been extended to multiple time scales in terms of the Multiscale Sample Entropy. The specific values of the entropy measures and their dependence on the time scales were analyzed with regard to the time elapsed since the operation, the type of surgical treatment and also the different depths of the rectum canal. The Mann-Whitney U test and Anova Friedman statistics indicate the statistically significant differences among all of stages of treatment and for all consecutive depths of rectum area for the estimated Sample Entropy. The further analysis at the multiple time scales signify the substantial differences among compared stages of treatment in the group of patients who underwent the lower anterior resection.
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Affiliation(s)
- Paulina Trybek
- Division of Computational Physics and Electronics, Institute of Physics, Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, 40007 Katowice, Poland
| | - Michal Nowakowski
- Department of General Surgery and Multiorgan Trauma, Jagiellonian University Medical College, 30048 Krakow, Poland
| | - Jerzy Salowka
- Department of Surgery, Stanley Dudrick Memorial Hospital, 32050 Skawina, Poland
| | - Jakub Spiechowicz
- Department of Theoretical Physics, Institute of Physics, Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, 40007 Katowice, Poland
| | - Lukasz Machura
- Division of Computational Physics and Electronics, Institute of Physics, Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, 40007 Katowice, Poland
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12
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Lin KY, Frawley HC, Granger CL, Denehy L. The Australian Pelvic Floor Questionnaire is a valid measure of pelvic floor symptoms in patients following surgery for colorectal cancer. Neurourol Urodyn 2016; 36:1395-1402. [PMID: 27778362 DOI: 10.1002/nau.23122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/24/2016] [Indexed: 12/26/2022]
Abstract
AIMS This study evaluated the construct validity of the Australian Pelvic Floor Questionnaire against two alternative measures of the severity of bladder and bowel symptoms. METHODS This was an exploratory analysis of data from two prospective studies. Patients who had undergone surgery for colorectal cancer were analysed. Bladder and bowel symptoms were measured using three validated questionnaires: the Australian Pelvic Floor Questionnaire, the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence and the International Consultation on Incontinence Questionnaire-Bowel Module post-cancer treatment. RESULTS The study sample consisted of 44 participants, including 25 men and 19 women. The Australian Pelvic Floor Questionnaire bladder and bowel domain scores demonstrated moderate positive correlations with the International Consultation on Incontinence Questionnaire Short Form Questionnaire for urinary incontinence (r = 0.74, P < 0.01) and the International Consultation on Incontinence Questionnaire-Bowel Module (r = 0.69-0.78, P < 0.01). Similar results were obtained in each gender subgroup. CONCLUSIONS This study suggested that the Australian Pelvic Floor Questionnaire may be a valid measurement tool for use in colorectal cancer populations in clinical trials and practice. Future research using larger cohorts is warranted.
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Affiliation(s)
- Kuan-Yin Lin
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Cabrini Health, Melbourne, Victoria, Australia.,Department of Physiotherapy, Melbourne Health, Melbourne, Victoria, Australia
| | - Helena C Frawley
- Cabrini Health, Melbourne, Victoria, Australia.,Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Catherine L Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Physiotherapy, Melbourne Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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