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Ivatury SJ, Suwanabol PA, Roo ACD. Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients. Clin Colon Rectal Surg 2024; 37:256-265. [PMID: 38882940 PMCID: PMC11178388 DOI: 10.1055/s-0043-1770720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Rectal cancer treatment often encompasses multiple steps and options, with benefits and risks that vary based on the individual. Additionally, patients facing rectal cancer often have preferences regarding overall quality of life, which includes bowel function, sphincter preservation, and ostomies. This article reviews these data in the context of shared decision-making approaches in an effort to better inform patients deliberating treatment options for rectal cancer.
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Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Ana C. De Roo
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, Missouri
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Singh R, White D, Romano G, Osenda E, Allen S, Dunstan M, Elangovan R, Jourdan I, Rockall T, Scala A. Factors affecting quality of life in rectal cancer survivors who have undergone laparoscopic surgery: patient-reported outcomes over 10 years at a single institution. Ann R Coll Surg Engl 2024; 106:13-18. [PMID: 36748787 PMCID: PMC10757878 DOI: 10.1308/rcsann.2022.0156] [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] [Accepted: 12/16/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Colorectal cancer survivors have many problems affecting their quality of life (QOL). Traditional follow-up focuses on the detection of recurrence rather than QOL. Efforts are being made to assess patient-reported outcomes (PROMS) more formally. Such changes may enable patients to consider QOL factors when deciding on treatment. METHODS Patients who underwent laparoscopic surgery for rectal cancer between 2005 and 2015 at a single institution were identified and sent European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29 QOL questionnaires. QOL and the impact of radiotherapy, chemotherapy and formation of end colostomy were assessed. RESULTS Some 141 patients were identified: 12 died and 118 (83.7%) responded, of whom 101 completed the questionnaires and 17 declined to participate; 11 were lost to follow-up. Mean age was 67 years, median follow-up was 58 months. Median QOL score was 6 (maximum 7) and 4.5% of patients reported a poor QOL score (<4). Significant rectal/perianal pain, sexual dysfunction and urinary symptoms were reported in 3.6%, 10.9% and 2.7% of respondents, respectively. Significant differences between treatment groups were uncommon. All cohorts reported similar QOL, functional and symptom scores. CONCLUSIONS These results compare favourably with the published data. Future studies may benefit from baseline assessment to better assess treatment impact, prescient in an increasingly elderly and comorbid population. This paper establishes that good PROMs are achievable with laparoscopic surgery for rectal cancer. It identifies limited differences in QOL between treatment modalities. Restoration of intestinal continuity and end colostomy result in similar QOL. This may address common concerns regarding stomata, sexual function and low anterior resection syndrome in this cohort.
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Affiliation(s)
- R Singh
- Royal Surrey NHS Foundation Trust, UK
| | - D White
- Royal Surrey NHS Foundation Trust, UK
| | - G Romano
- Royal Surrey NHS Foundation Trust, UK
| | - E Osenda
- Royal Surrey NHS Foundation Trust, UK
| | - S Allen
- Royal Surrey NHS Foundation Trust, UK
| | - M Dunstan
- Royal Surrey NHS Foundation Trust, UK
| | | | - I Jourdan
- Royal Surrey NHS Foundation Trust, UK
| | - T Rockall
- Royal Surrey NHS Foundation Trust, UK
| | - A Scala
- Royal Surrey NHS Foundation Trust, UK
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Ghomeshi A, Zizzo J, Reddy R, White J, Swayze A, Swain S, Ramasamy R. The erectile and ejaculatory implications of the surgical management of rectal cancer. Int J Urol 2023; 30:827-837. [PMID: 37365839 DOI: 10.1111/iju.15235] [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: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
Colorectal cancer is a significant cause of cancer-related deaths worldwide. Although advances in surgical technology and technique have decreased mortality rates, surviving patients often experience sexual dysfunction as a common complication. The development of the lower anterior resection has greatly decreased the use of the radical abdominoperineal resection surgery, but even the less radical surgery can result in sexual dysfunction, including erectile and ejaculatory dysfunction. Improving the knowledge of the underlying causes of sexual dysfunction in this context and developing effective strategies for preventing and treating these adverse effects are essential to improving the quality of life for postoperative rectal cancer patients. This article aims to provide a comprehensive evaluation of erectile and ejaculatory dysfunction in postoperative rectal cancer patients, including their pathophysiology and time course and strategies for prevention and treatment.
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Affiliation(s)
- Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - John Zizzo
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Raghuram Reddy
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Joshua White
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aden Swayze
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Campelo P, Barbosa E. Functional outcome and quality of life following treatment for rectal cancer. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2016.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Introduction Over the last decades, treatment for rectal cancer has substantially improved with development of new surgical options and treatment modalities. With the improvement of survival, functional outcome and quality of life are getting more attention.
Study objective To provide an overview of current modalities in rectal cancer treatment, with particular emphasis on functional outcomes and quality of life.
Results Functional outcomes after rectal cancer treatment are influenced by patient and tumor characteristics, surgical technique, the use of preoperative radiotherapy and the method and level of anastomosis. Sphincter preserving surgery for low rectal cancer often results in poor functional outcomes that impair quality of life, referred to as low anterior resection syndrome. Abdominoperineal resection imposes the need for a permanent stoma but avoids the risk of this syndrome. Contrary to general belief, long-term quality of life in patients with a permanent stoma is similar to those after sphincter preserving surgery for low rectal cancer.
Conclusion All patients should be informed about the risks of treatment modalities. Decision on rectal cancer treatment should be individualized since not all patients may benefit from a sphincter preserving surgery “at any price”. Non-resection treatment should be the future focus to avoid the need of a permanent stoma and bowel dysfunction.
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Affiliation(s)
- Pedro Campelo
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Elisabete Barbosa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
- Centro Hospitalar São João, Departamento de Cirurgia Colorretal, Porto, Portugal
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Silva KDA, Duarte AX, Cruz AR, de Araújo LB, Pena GDG. Time after ostomy surgery and type of treatment are associated with quality of life changes in colorectal cancer patients with colostomy. PLoS One 2020; 15:e0239201. [PMID: 33270661 PMCID: PMC7714142 DOI: 10.1371/journal.pone.0239201] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/01/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Quality of life in colorectal cancer patients may be affected by colostomy and treatment, but relevant studies are still scarce and contradictory. The present study aimed to evaluate the association between colostomy time and treatment type with quality of life in colorectal cancer patients. Methods A prospective observational study of 41 patients with colorectal cancer was conducted on three occasions T0, T1 and T2 (0–2; 3–5 and 6–8 months after ostomy surgery, respectively). The treatments prescribed were: surgery alone, chemotherapy or radiotherapy, or chemoradiotherapy. European Organization for Research and Treatment of Cancer questionnaires were used to evaluate quality of life. Worsening clinical changes were evaluated considering difference in scores between times of surgery ≥±9 points. Results Regarding ostomy surgery, scores in physical function improved between T0 and T1 and these better scores were maintained at T1 to T2. The same was observed for urinary frequency, appetite loss and dry mouth. Chemoradiotherapy was associated with worse scores for global health status, nausea and vomiting, bloating and dry mouth. Although significant differences were not observed in some domains in the Generalized Estimating Equations analysis, patients showed noticeable changes for the worse in the pain, anxiety, weight concern, flatulence and embarrassment domains during these periods. Conclusions Colostomy improved quality of life at 3–5 months in most domains of quality of life and remained better at 6–8 months after surgery. Chemoradiotherapy had a late negative influence on quality of life. Health teams could use these results to reassure patients that this procedure will improve their quality of life in many functional and symptomatic aspects.
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Affiliation(s)
- Karine de Almeida Silva
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Arenamoline Xavier Duarte
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Amanda Rodrigues Cruz
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Lúcio Borges de Araújo
- School of Mathematics, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Geórgia das Graças Pena
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- School of Medicine, Nutrition Course, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- * E-mail: ,
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Walming S, Asplund D, Bock D, Gonzalez E, Rosenberg J, Smedh K, Angenete E. Quality of life in patients with resectable rectal cancer during the first 24 months following diagnosis. Colorectal Dis 2020; 22:2028-2037. [PMID: 32871612 PMCID: PMC7821207 DOI: 10.1111/codi.15343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 01/09/2023]
Abstract
AIM An increasing number of patients survive rectal cancer, resulting in more patients living with the side-effects of the treatment. Exploring quality of life before and after treatment enables follow-up and additional treatment to be adjusted to the patient's needs. The aim of the study was to describe the quality of life during the 24 months following diagnosis and to identify risk factors for poor quality of life. METHOD This is a prospective cohort study of patients with rectal cancer followed up by extensive questionnaires. Patients from 16 surgical departments in Denmark and Sweden from 2012 to 2015 were included. The self-assessed quality of life was measured with a seven-point Likert scale. RESULTS A total of 1110 patients treated with curative intent were included, and the response rate at the 24-month follow-up was 71%. Patients with rectal cancer assessed their quality of life before start of treatment as poorer than that of a reference population. At the 12- and 24-month follow-up, the quality of life on group level had recovered to the same level as for the reference population. Risk factors for poor quality of life included bother with urinary, bowel and stoma function. A reference population was used for comparison. CONCLUSION The quality of life of patients with resectable rectal cancer recovered to levels comparable to a reference population 12 and 24 months after diagnosis. Our results indicate that the urinary, bowel and stoma function has an impact on quality of life.
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Affiliation(s)
- S. Walming
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - D. Asplund
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - D. Bock
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - E. Gonzalez
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - J. Rosenberg
- Department of SurgeryHerlev HospitalUniversity of CopenhagenHerlevDenmark
| | - K. Smedh
- Department of SurgeryVästmanland Hospital VästeråsVästeråsSweden
| | - E. Angenete
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
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Bao F, Shang J, Xiang C, Li G, Zhi X, Liu W, Wang D, Xian-Yu J, Deng Z. Gender aspects of survival after abdominoperineal resection for low rectal cancer: a retrospective study. Int J Colorectal Dis 2020; 35:2001-2010. [PMID: 32564125 DOI: 10.1007/s00384-020-03671-2] [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] [Accepted: 06/10/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The difference in prognosis between genders after abdominoperineal resection (APR) for low rectal cancer (LRC) is unclear. This study aimed to compare survival outcomes between genders in patients with LRC who underwent curative APR. METHODS This retrospective cohort study used a database of consecutive colorectal resections. Patients who received curative APR with LRC were grouped according to their gender. Female patients were frequency-matched 1:1 on American Joint Committee on Cancer (AJCC) stage to male patients. Overall survival (OS), disease-free survival (DFS), and their independent risk factors were examined. RESULTS A total of 140 patients with APR for LRC were included after matching: 70 (50.0%) males and 70 (50.0%) females. No significant differences were found between the groups in terms of age, operation methods, AJCC stage, and adjuvant therapy (all P > 0.05). Median follow-up was 39 (range: 3-128) months. Male gender was independently associated with worse OS (adjusted hazard ratio [HR] = 2.755, 95% CI: 1.507-5.038, P = 0.001) and worse DFS (adjusted HR = 2.440, 95% CI: 1.254-4.746, P = 0.009). Subgroup analysis revealed that female patients with stage III disease had better OS (P = 0.001) and DFS (P < 0.001) than male patients. CONCLUSION Gender affects survival after a curative APR for LRC. Compared with females, male patients with LRC after curative APR had worse prognosis, especially for stage III disease.
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Affiliation(s)
- Feng Bao
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Jianying Shang
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Chunhua Xiang
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Guoqiang Li
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Xing Zhi
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Wen Liu
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Dong Wang
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Jianbo Xian-Yu
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China
| | - Zhigang Deng
- Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang, 621000, Sichuan, China.
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Hirpara DH, Azin A, Mulcahy V, Le Souder E, O’Brien C, Chadi SA, Quereshy FA. The impact of surgical modality on self-reported body image, quality of life and survivorship after anterior resection for colorectal cancer – a mixed methods study. Can J Surg 2020; 62:235-242. [PMID: 30900436 DOI: 10.1503/cjs.014717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background There is growing enthusiasm for robotic and transanal surgery as an alternative to open or laparoscopic surgery for colorectal cancer (CRC). We examined the impact of surgical modality on body image and quality of life (QOL) in patients receiving anterior resection for CRC. Methods We used a mixed-methods approach, consisting of a chart review and semistructured interviews with CRC patients, at least 8 months after surgery. We assessed cosmetic outcomes and QOL using validated questionnaires. Results Thirty patients were stratified into open (n = 8), laparoscopic (n = 12) and robotic (n = 10) groups. Mean body image scores were significantly higher (i.e., poorer body image) in patients receiving open surgery (mean difference [MD] +5.7 with laparoscopy, p < 0.001). Open surgery was more detrimental to physical function, including strenuous activities, prolonged ambulation and self-care (MD –11.6 with laparoscopy, p = 0.039). Patients receiving laparoscopic surgery reported superior role (MD +27.6 with open surgery, p = 0.002) and social function (MD +13.7 with open surgery, p = 0.042), including the ability to enjoy hobbies, family life and social activities. Surgical modality did not impact emotional and cognitive function or symptoms including genitourinary function, pain and defecation. Conclusion The negative impact of open surgery on body image and physical function warrants further educational interventions for patients. The protective effect of laparoscopy on role and function may be associated with “tumour factors” that are unaccounted for in the European Organization for Research and Treatment of Cancer questionnaires. Open surgery is detrimental to body image and physical function in patients receiving anterior resection for CRC. Prospective randomized studies are required to validate these findings.
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Affiliation(s)
- Dhruvin H. Hirpara
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Hirpara, Azin); the Division of General Surgery, University Health Network, Toronto, Ont. (Mulcahy, O’Brien, Chadi, Quereshy); and the Faculty of Medicine, University of Toronto, Toronto, Ont. (Le Souder)
| | - Arash Azin
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Hirpara, Azin); the Division of General Surgery, University Health Network, Toronto, Ont. (Mulcahy, O’Brien, Chadi, Quereshy); and the Faculty of Medicine, University of Toronto, Toronto, Ont. (Le Souder)
| | - Virginia Mulcahy
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Hirpara, Azin); the Division of General Surgery, University Health Network, Toronto, Ont. (Mulcahy, O’Brien, Chadi, Quereshy); and the Faculty of Medicine, University of Toronto, Toronto, Ont. (Le Souder)
| | - Emily Le Souder
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Hirpara, Azin); the Division of General Surgery, University Health Network, Toronto, Ont. (Mulcahy, O’Brien, Chadi, Quereshy); and the Faculty of Medicine, University of Toronto, Toronto, Ont. (Le Souder)
| | - Catherine O’Brien
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Hirpara, Azin); the Division of General Surgery, University Health Network, Toronto, Ont. (Mulcahy, O’Brien, Chadi, Quereshy); and the Faculty of Medicine, University of Toronto, Toronto, Ont. (Le Souder)
| | - Sami A. Chadi
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Hirpara, Azin); the Division of General Surgery, University Health Network, Toronto, Ont. (Mulcahy, O’Brien, Chadi, Quereshy); and the Faculty of Medicine, University of Toronto, Toronto, Ont. (Le Souder)
| | - Fayez A. Quereshy
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Hirpara, Azin); the Division of General Surgery, University Health Network, Toronto, Ont. (Mulcahy, O’Brien, Chadi, Quereshy); and the Faculty of Medicine, University of Toronto, Toronto, Ont. (Le Souder)
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Predictive Factors for Bowel Dysfunction After Sphincter-Preserving Surgery for Rectal Cancer: A Single-Center Cross-sectional Study. Dis Colon Rectum 2019; 62:925-933. [PMID: 30855308 DOI: 10.1097/dcr.0000000000001374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND With increasing rates of sphincter preservation because of advances in preoperative chemoradiation, restoration of bowel continuity has become a main goal of rectal cancer treatment. However, in many patients, postoperative bowel dysfunction negatively affects the quality of life. OBJECTIVE This study aimed to analyze predictors of bowel dysfunction after sphincter-preserving surgery in patients with rectal cancer. DESIGN This was a cross-sectional study. SETTINGS Assessment of bowel dysfunction was conducted between November 2015 and June 2017 at our institution. PATIENTS A total of 316 patients with rectal cancer who underwent sphincter-preserving surgery between February 2009 and April 2017 and agreed with an interview for assessing bowel dysfunction were included. MAIN OUTCOME MEASURES Bowel dysfunction was assessed with the Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner score. All the assessments were conducted face-to-face by the same interviewer. RESULTS The median time interval between the restoration of bowel continuity and assessment was 10 months (interquartile range, 3-37), and the median total Memorial Sloan Kettering Cancer Center and Wexner scores were 65 (interquartile range, 58-73) and 6 (interquartile range, 0-11). The time interval was correlated with the Memorial Sloan Kettering Cancer Center scores (rho, 0.279) and Wexner scores (rho, -0.306). In a multivariate analysis, handsewn anastomosis and short time interval (≤1 year) were independently associated with poor bowel function (Memorial Sloan Kettering Cancer Center score ≤65). A short time interval (≤1 year), preoperative chemoradiation, and ileostomy were independently associated with major fecal incontinence (Wexner ≥8). LIMITATIONS Selection bias may be inherent. CONCLUSIONS Bowel function recovers with time after the restoration of bowel continuity. A short time interval, handsewn anastomosis, preoperative chemoradiation, and ileostomy were significantly associated with poor bowel function or major fecal incontinence. Surgeons should discuss postoperative bowel dysfunction and its predictive factors with the patients. See Video Abstract at http://links.lww.com/DCR/A930.
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Hirata Y, Nozawa H, Kawai K, Hata K, Tanaka T, Nishikawa T, Otani K, Sasaki K, Kaneko M, Emoto S. The influence of neoadjuvant chemoradiation for lower rectal cancer on urinary function. Asian J Surg 2019; 42:731-739. [DOI: 10.1016/j.asjsur.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/07/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022] Open
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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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Outcomes of Rectal Cancer Patients With Low Sphincter-Preserving Operations Compared to Patients With Abdominoperineal Resection. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0404-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Herrinton LJ, Altschuler A, McMullen CK, Bulkley JE, Hornbrook MC, Sun V, Wendel CS, Grant M, Baldwin CM, Demark-Wahnefried W, Temple LKF, Krouse RS. Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery. CA Cancer J Clin 2016; 66:387-97. [PMID: 26999757 PMCID: PMC5618707 DOI: 10.3322/caac.21345] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/13/2016] [Accepted: 02/09/2016] [Indexed: 12/14/2022] Open
Abstract
For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society.
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Affiliation(s)
- Lisa J Herrinton
- Senior Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andrea Altschuler
- Senior Consultant, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Carmit K McMullen
- Investigator, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Joanna E Bulkley
- Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Mark C Hornbrook
- Chief Scientist, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Virginia Sun
- Assistant Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Christopher S Wendel
- Research Instructor, Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | - Marcia Grant
- Distinguished Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Carol M Baldwin
- Professor Emerita and Southwest Borderlands Scholar, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Wendy Demark-Wahnefried
- Professor and Webb Endowed Chair of Nutrition Sciences, Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Larissa K F Temple
- Colorectal Surgical Oncologist, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert S Krouse
- Staff General and Oncologic Surgeon, Professor of Surgery, Southern Arizona Veterans Affairs Health Care System and University of Arizona College of Medicine, Tucson, AZ
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Hung SL, Lin YH, Yang HY, Kao CC, Tung HY, Wei LH. Pelvic floor muscle exercise for fecal incontinence quality of life after coloanal anastomosis. J Clin Nurs 2016; 25:2658-68. [PMID: 27461451 DOI: 10.1111/jocn.13314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 01/30/2023]
Abstract
AIMS AND OBJECTIVES To assess the efficacy of pelvic floor muscle exercise for enhancing fecal incontinence quality of life after coloanal anastomosis in colorectal cancer patients. BACKGROUND Methods of improving incontinence have been evaluated in many countries, but never in a Taiwan population. DESIGN A longitudinal experimental study. METHODS Fifty-two colorectal cancer patients who had received colostomy closure and coloanal anastomosis surgery were recruited from a general hospital in southern Taiwan and randomly assigned to an experimental group (n = 26) or a control group (n = 26). Both groups received routine postoperative care. However, the experimental group received private consultations, educational DVDs and pamphlets to instruct them in performing pelvic flow muscle exercise. In all participants, the Fecal Incontinence Quality of Life Scale was used to measure quality of life before discharge and at one, two, three, six and nine months after discharge. Generalised estimating equations were used to compare longitudinal effects between the two groups. RESULTS The generalised estimating equations revealed that all participants had significantly improved Fecal Incontinence Quality of Life Scale scores at two, three, six and nine months after discharge. Compared to the controls, however, the experimental group had significantly higher scores at two, three, and six months after discharge. CONCLUSIONS Patient education in pelvic floor muscle exercise positively affects Fecal Incontinence Quality of Life Scale scores in patients who have received coloanal anastomosis. RELEVANCE TO CLINICAL PRACTICE Early education in pelvic floor muscle exercise can improve management of fecal incontinence symptoms after coloanal anastomosis and can improve quality of life.
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Affiliation(s)
- Shu-Ling Hung
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Yu-Hua Lin
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan.
| | - Hsing-Yu Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Chia-Chan Kao
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Hong-Yu Tung
- Surgery Department, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Li-Hsiang Wei
- Nursing Department, E-DA Hospital, Kaohsiung, Taiwan
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15
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Gilmore B, Ezekian B, Sun Z, Peterson A, Mantyh C. Urinary Dysfunction in the Rectal Cancer Survivor. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Fecal Incontinence and Quality of Life in Adults With Rectal Cancer After Lower Anterior Resection. J Wound Ostomy Continence Nurs 2015; 42:395-400. [DOI: 10.1097/won.0000000000000135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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17
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Lin YH, Yang HY, Hung SL, Chen HP, Liu KW, Chen TB, Chi SC. Effects of pelvic floor muscle exercise on faecal incontinence in rectal cancer patients after stoma closure. Eur J Cancer Care (Engl) 2015; 25:449-57. [PMID: 25684312 DOI: 10.1111/ecc.12292] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine the effects of pelvic floor muscle exercise (PFME) on the faecal incontinence (FI) of rectal cancer patients following stoma closure. Participants were randomly distributed into an exercise group (n = 27) and non-exercise group (n = 26). An experimental design and longitudinal approach were implemented for data collection. Baseline data were collected at 1 day before discharge, and then PFME was taught before the patients were discharged from the hospital. We collected data and followed up with the patients at their pre-discharge visit and at 1, 2, 3, 6 and 9 months after discharge. The Cleveland Clinic Faecal Incontinence (CCI) score was used to measure patient outcome. PFME proved to effectively decrease the degree of FI in stoma closure recipients. The FI score of the exercise group significantly decreased from 8.37 to 2.27 after PFME compared with that of the non-exercise group (from 8.54 to 2.58). The generalised estimation equation tests showed that both group and time were significantly different. The tests also indicated that although PFME appeared to hasten the decline of incontinence, this effect was no longer detectable at 9 months; thus, it may be an effective intervention for FI when implemented up to half a year after discharge.
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Affiliation(s)
- Y-H Lin
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - H-Y Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - S-L Hung
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - H-P Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-DA Hospital, Kaohsiung, Taiwan
| | - K-W Liu
- Division of Colon and Rectal Surgery, Department of Surgery, E-DA Hospital, Kaohsiung, Taiwan
| | - T-B Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, Kaohsiung, Taiwan
| | - S-C Chi
- Nursing Department, E-DA Hospital, Kaohsiung, Taiwan
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18
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Bregendahl S, Emmertsen KJ, Lindegaard JC, Laurberg S. Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis 2015; 17:26-37. [PMID: 25156386 DOI: 10.1111/codi.12758] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/29/2014] [Accepted: 07/15/2014] [Indexed: 02/08/2023]
Abstract
AIM Knowledge of urinary and sexual dysfunction in women after rectal cancer treatment is limited. This study addresses this in relation to the use of preoperative radiotherapy, type of surgery and the presence of bowel dysfunction. METHOD All living female patients who underwent abdominoperineal excision (APE) or low anterior resection (LAR) for rectal cancer in Denmark between 2001 and 2007 were identified. Validated questionnaires (the ICIQ-FLUTS and the SVQ) on urinary and sexual function were completed by 516 (75%) and 482 (72%) recurrence-free patients in 2009. RESULTS Urgency and incontinence were reported by 77 and 63% of respondents, respectively. Vaginal dryness, dyspareunia and reduced vaginal dimensions occurred in 72, 53 and 29%, respectively, and 69% reported that they had little/no sexual desire. Preoperative radiotherapy was associated with voiding difficulties (OR = 1.63, 95% CI 1.09-2.44), reduced vaginal dimensions (OR = 4.77, 95% CI 1.97-11.55), dyspareunia (OR = 2.76, 95% CI 1.12-6.79), lack of desire (OR = 2.22, 95% CI 1.09-4.53) and reduced sexual activity (OR = 0.55, 95% CI 0.30-0.98). Patients undergoing APE had a higher risk of dyspareunia (OR = 2.61, 95% CI 1.00-6.85). Bowel dysfunction after LAR was associated with bladder storage difficulties (OR = 1.64, 95% CI 1.01-2.65), symptoms of incontinence (OR = 2.17, 95% CI 1.35-3.50), lack of sexual desire (OR = 2.69, 95% CI 1.21-5.98), sexual inactivity (OR = 0.48, 95% CI 0.24-0.96) and sexual dissatisfaction (OR = 0.40, 95% CI 0.20-0.82). CONCLUSION Urinary and sexual problems are common in women after treatment for rectal cancer. Preoperative radiotherapy interferes with several aspects of urinary and sexual functioning. Bowel dysfunction after LAR is associated with urinary dysfunction and a reduction in sexual desire, activity and satisfaction.
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Affiliation(s)
- S Bregendahl
- Surgical Research Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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19
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Wang XT, Li DG, Li L, Kong FB, Pang LM, Mai W. Meta-analysis of oncological outcome after abdominoperineal resection or low anterior resection for lower rectal cancer. Pathol Oncol Res 2014; 21:19-27. [PMID: 25430561 PMCID: PMC4287681 DOI: 10.1007/s12253-014-9863-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/22/2014] [Indexed: 12/16/2022]
Abstract
In lower rectal cancer, postoperative outcome is still subject of controversy between the advocates of abdominoperineal resection (APR) and low anterior resection (LAR). Reports suggest that low anterior resection may be oncologically superior to abdominoperineal excision, although no good evidence exists to support this. Publications were identified which assessed the differences comparing 5-year survival, local recurrence, circumferential resection margin rate, complications and so on. A meta-analysis was performed to clarify the safety and feasibility of the two procedures with several types of outcome measures. A total of 13 studies met the inclusion criteria, and comprised 6,850 cases. Analysis of these data showed that LAR group was highly correlated with 5-year survival (pooled OR = 1.73, 95%CI: 1.30–2.29, P = 0.0002 random-effect). And local recurrence rate of APR group was significantly higher than that in LAR group (pooled OR = 0.63, 95%CI: 0.53–0.75, P < 0.00001 fixed-effect). Also, the circumferential resection margin (CRM) were high involved in APR group than in LAR group. (5 trials reported the data, pooled OR = 0.43, 95%CI: 0.36–0.52, P < 0.00001 fixed-effect). Besides, the incidents of overall complications of APR group was higher compared with LAR group (pooled OR = 0.52, 95%CI: 0.29–0.92, P = 0.03 random-effect). Patients treated by APR have a higher rate of CRM involvement, a higher local recurrence, and poorer prognosis than LAR. And there is evidence that in selected low rectal cancer patients, LAR can be used safely with a better oncological outcome than APR. due to the inherent limitations of the present study, for example, the trails available for this systematic review are limited and the finite retrospective data, future prospective randomized controlled trials will be useful to fully investigate these outcome measures and to confirm this conclusion.
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Affiliation(s)
- Xiao-Tong Wang
- Departments of Gastrointestinal and Peripheral Vascular Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China,
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20
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Hamaker ME, Prins MC, Schiphorst AH, van Tuyl SAC, Pronk A, van den Bos F. Long-term changes in physical capacity after colorectal cancer treatment. J Geriatr Oncol 2014; 6:153-64. [PMID: 25454769 DOI: 10.1016/j.jgo.2014.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/19/2014] [Accepted: 10/05/2014] [Indexed: 11/18/2022]
Abstract
Older patients with colorectal cancer are faced with the dilemma of choosing between the short-term risks of treatment and the long-term risks of insufficiently treated disease. In addition to treatment-related morbidity and mortality, patients may suffer from loss of physical capacity. The purpose of this review was to gather all available evidence regarding long-term changes in physical functioning and role functioning after colorectal cancer treatment, by performing a systematic Medline and Embase search. This search yielded 27 publications from 23 studies. In 16 studies addressing physical functioning after rectal cancer treatment, a median drop of 10% (range -26% to -5%) in the mean score for this item at three months. At six months, mean score was still 7% lower than baseline (range -18% to 0%) and at twelve months 5% lower (range -13% to +5%). For role functioning (i.e. ability to perform daily activities) after rectal cancer treatment, scores were -18% (range -39% to -2%), -8% (range -23% to +6%) and -5% (range -17% to +10%) respectively. Elderly patients experience the greatest and most persistent decline in self-care capacity (up to 61% at one year). This systematic review demonstrates that both physical functioning and role functioning are significantly affected by colorectal cancer surgery. Although initial losses are recovered partially during follow-up, there is a permanent loss in both aspects of physical capacity, in patients of all ages but especially in the elderly. This aspect should be included in patient counselling regarding surgery.
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Affiliation(s)
- Marije E Hamaker
- Diakonessenhuis Utrecht/Zeist/Doorn, Department of Geriatric Medicine, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - Meike C Prins
- Diakonessenhuis Utrecht/Zeist/Doorn, Department of Geriatric Medicine, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | | | | | - Apollo Pronk
- Department of Surgery, Diakonessenhuis Utrecht, The Netherlands
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21
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Angenete E, Asplund D, Andersson J, Haglind E. Self reported experience of sexual function and quality after abdominoperineal excision in a prospective cohort. Int J Surg 2014; 12:1221-7. [PMID: 25311774 DOI: 10.1016/j.ijsu.2014.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/25/2014] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Rectal cancer treatment, especially abdominoperineal excision (APE), can cause sexual dysfunction. There are indications that pre-operative information regarding sexual dysfunction is inadequate. The aim of this study was to explore self reported sexual function in a group of patients operated with APE and the patients' remembrance of preoperative information more than one year after their surgical procedure. METHODS Consecutive patients with rectal cancer operated with APE in one institution between 2004 and 2009 were included. Data was collected from hospital records and the Swedish Colorectal cancer registry. A detailed questionnaire was sent out to the patients 13-84 months post-operatively. RESULTS One hundred and eight patients were alive in February 2011, 84 agreed to participate and 89% returned the questionnaire. Men and women did not differ regarding age, tumour stage, neoadjuvant treatment or type of surgical procedure. More men were involved in a relationship; men had more thoughts about sex, were less satisfied and were more bothered than women by their sexual dysfunction. A majority of patients did not retain sufficient knowledge from the preoperative information regarding sexual dysfunction. DISCUSSION This exploratory study shows that although sexual activity was similar between the two genders, men reported more bother by their self-reported sexual dysfunction after an APE than women did. However, both men and women felt that the preoperative information was inadequate. CONCLUSION Surgeons should focus more on information about the risk of sexual dysfunction as well as on its treatment at follow-up. TRIAL REGISTRATION ClinicalTrials.gov, NCT01323166.
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Affiliation(s)
- Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, SSORG - Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
| | - Dan Asplund
- Department of Surgery, Institute of Clinical Sciences, SSORG - Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - John Andersson
- Department of Surgery, Institute of Clinical Sciences, SSORG - Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Department of Surgery, Alingsås Hospital, Alingsås, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, SSORG - Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Li DG, Kong FB, Liu CQ, Pang LM. Meta-analysis of oncological outcomes after abdominoperineal resection vs low anterior resection for lower rectal cancer. Shijie Huaren Xiaohua Zazhi 2014; 22:4027-4035. [DOI: 10.11569/wcjd.v22.i26.4027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the oncological outcome of abdominoperineal resection (APR) and low anterior resection (LAR) for lower rectal cancer.
METHODS: Publications that compared 5-year survival, local recurrence, circumferential resection margin (CRM) involvement rate, and complications were identified by literature search. A meta-analysis was performed to clarify the safety and feasibility of the two procedures with regards to several types of outcome measures.
RESULTS: A total of 11 studies met the inclusion criteria, including 6544 cases. Analysis of these data showed that the LAR group was associated with a higher 5-year survival rate (pooled RR = 1.18, 95%CI: 1.08-1.30, P < 0.00001, random-effect). Local recurrence rate (pooled RR = 0.67, 95%CI: 0.57-0.78, P < 0.00001, fixed-effect) and CRM involvement rate (4 trials reported the data, pooled RR = 0.49, 95%CI: 0.38-0.62, P < 0.00001, random-effect) were significantly higher in the APR group than in the LAR group. Besides, the incidence of overall complications in the APR group was significantly higher than that in the LAR group (pooled RR = 0.60, 95%CI: 0.38-0.93, P = 0.02, random-effect).
CONCLUSION: Patients treated by APR have a higher rate of CRM involvement, higher local recurrence, and poorer prognosis than those by LAR. When performed with appropriate skill, LAR can be used safely with a better oncological outcome.
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Gavaruzzi T, Lotto L, Giandomenico F, Perin A, Pucciarelli S. Patient-reported outcomes after neoadjuvant therapy for rectal cancer: a systematic review. Expert Rev Anticancer Ther 2014; 14:901-18. [PMID: 24745308 DOI: 10.1586/14737140.2014.911090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neoadjuvant therapy followed by total mesorectal excision is standard of care for locally advanced rectal cancer. However, this approach has been previously shown to be associated with high rate of morbidity and it may have a negative effect on patients' reported outcomes (PROs). In order to summarize findings on the effect of the neoadjuvant approach on PROs, we systematically reviewed articles published in the last five years. Thirty-five articles met the inclusion criteria. Ten articles compared the effect of surgery with and without neoadjuvant therapy, six articles compared different neoadjuvant therapies, ten articles reported on patients who were all treated with neoadjuvant therapy, and nine articles examined the effect of neoadjuvant therapy in the analyses. The results are summarized by function investigated and critically commented.
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Affiliation(s)
- Teresa Gavaruzzi
- Clinica Chirurgica I, Policlinico Universitario, via Giustiniani, 2, 35128 Padova, Italy
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Wu R, Boushey R, Potter B, Stacey D. The evaluation of a rectal cancer decision aid and the factors influencing its implementation in clinical practice. BMC Surg 2014; 14:16. [PMID: 24655353 PMCID: PMC3998110 DOI: 10.1186/1471-2482-14-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/12/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Colorectal cancer is common in North America. Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. A rectal cancer decision aid was developed using the International Patient Decision Aid Standards to facilitate patients being more actively involved in making this decision with the surgeon. The overall aim of this study is to evaluate this decision aid and explore barriers and facilitators to implementing in clinical practice. METHODS First, a pre- and post- study will be guided by the Ottawa Decision Support Framework. Eligible patients from a colorectal cancer center include: 1) adult patients diagnosed with rectal cancer, 2) tumour at a maximum of 10 cm from anal verge, and 3) surgeon screened candidates eligible to consider both low anterior resection and abdominoperineal resection. Patients will be given a paper-version and online link to the decision aid to review at home. Using validated tools, the primary outcomes will be decisional conflict and knowledge of surgical options. Secondary outcomes will be patient's preference, values associated with options, readiness for decision-making, acceptability of the decision aid, and feasibility of its implementation in clinical practice. Proposed analysis includes paired t-test, Wilcoxon, and descriptive statistics. Second, a survey will be conducted to identify the barriers and facilitators of using the decision aid in clinical practice. Eligible participants include Canadian surgeons working with rectal cancer patients. Surgeons will be given a pre-notification, questionnaire, and three reminders. The survey package will include the patient decision aid and a facilitators and barriers survey previously validated among physicians and nurses. Principal component analysis will be performed to determine common themes, and logistic regression will be used to identify variables associated with the intention to use the decision aid. DISCUSSION This study will evaluate the impact of the rectal cancer decision aid on patients and help with planning strategies to overcome barriers and facilitate implementation of the decision aid in routine clinical practice. To our knowledge this is the first study designed to evaluate a decision aid in the field of colorectal surgery.
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Affiliation(s)
- Robert Wu
- The Ottawa Hospital General Campus, 501 Smyth Rd., Ottawa, Ontario K1H 8L6, Canada
| | - Robin Boushey
- Department of Surgery, The Ottawa Hospital General Campus, 501 Smyth Rd., Rm 1617, Critical Care Wing, Ottawa, ON K1H8L6, Canada
| | - Beth Potter
- Department of Epidemiology & Community Medicine, The University of Ottawa, 451 Smyth Rd. RGN 3230F, Ottawa, ON K1H8M5, Canada
| | - Dawn Stacey
- Department of Epidemiology & Community Medicine, Centre for Practice Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital General Campus, 501 Smyth Rd., Ottawa, ON K1H8L6, Canada
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25
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Gavaruzzi T, Giandomenico F, Del Bianco P, Lotto L, Perin A, Pucciarelli S. Quality of life after surgery for rectal cancer. Recent Results Cancer Res 2014; 203:117-149. [PMID: 25103003 DOI: 10.1007/978-3-319-08060-4_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients' health-related quality of life (HRQoL) is now considered a relevant clinical outcome. This study systematically reviewed articles published in the last 5 years, focusing on the impact of rectal cancer treatment on patients' HRQoL. Of the 477 articles retrieved, 56 met the inclusion criteria. The most frequently reported comparisons were between surgical procedures (21 articles), especially between sphincter-preserving and non-sphincter preserving surgery or between stoma and stoma-free patients (13 articles), and between multimodality therapies (11 articles). Additionally, twelve articles compared patients' and healthy controls' HRQoL as primary or secondary aim. The majority of the studies were observational (84 %), controlled (66 %), cross-sectional (54 %), prospective (100 %), with a sample of more than 100 patients (59 %), and with more than 60 % of patients treated with neoadjuvant therapy (50 %). The most frequently used instruments were the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30), its colorectal cancer specific module QLQ-CR38, and the Medical Outcomes Study Short-Form 36 items questionnaire. Findings from the included articles are summarised and commented, with a special focus on the comparison between surgical treatments, between irradiated and not-irradiated patients, and between patients and the general population.
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Affiliation(s)
- Teresa Gavaruzzi
- Department of Surgical Oncological and Gastroenterological Sciences-First Surgical Clinic, University of Padova, Padua, Italy,
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Cumulative incidence of permanent stoma after sphincter preserving low anterior resection of mid and low rectal cancer. Dis Colon Rectum 2013; 56:1134-42. [PMID: 24022530 DOI: 10.1097/dcr.0b013e31829ef472] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Changes in the treatment of rectal cancer during the past decades have led to an increase in sphincter preservation with a consecutive decline in abdominoperineal resection rates. OBJECTIVE The aim of this study was to analyze the cumulative incidence of permanent stoma in patients undergoing sphincter-preserving resection of mid and low rectal cancer. DESIGN This study is a retrospective analysis of prospectively collected data. SETTINGS This study was conducted at a tertiary referral cancer hospital. PATIENTS From 2003 to 2010, 125 patients with primary mid and low rectal cancer who underwent sphincter-preserving low anterior resection were included. MAIN OUTCOME MEASURES The occurrence of a permanent stoma over time was investigated by using a Cox proportional hazards regression model and competing-risk models, with death as a competing risk. The risk factors were assessed by computing HRs and a Cox proportional hazards regression. RESULTS After a median follow-up time of 61 months (range, 22-113), 15 of 125 patients ended up with a permanent stoma, accounting for a 5-year cumulative incidence of 6% (95% CI, 4%-11%). The reasons for obtaining a permanent stoma were anastomotic leakage (60%, 9/15), intractable fecal incontinence (27%, 4/15), and local recurrence (13%, 2/15). The Cox proportional hazards regression identified anastomotic leakage (HR, 6.10; 95% CI, 2.23-16.71; p = 0.0004) and coloanal anastomosis (HR, 4.31; 95% CI, 1.49-12.47; p = 0.007) as statistically significant risk factors. LIMITATIONS Because of the small number of events in this sample, further investigations with a larger number of patients are required. Fecal incontinence was assessed by patient self-reported data without the use of a validated score. CONCLUSION The 5-year cumulative incidence of a permanent stoma was 6%. Anastomotic leakage and coloanal anastomosis were identified as risk factors. These details should be considered before sphincter-preserving surgery.
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Randomized controlled trial of tamsulosin for prevention of acute voiding difficulty after rectal cancer surgery. World J Surg 2013; 36:2730-7. [PMID: 22806208 DOI: 10.1007/s00268-012-1712-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We conducted a randomized clinical trial to investigate the efficacy of the selective α(1A)-adrenoceptor antagonist tamsulosin in preventing acute voiding difficulty after rectal cancer surgery. METHODS A total of 94 rectal cancer patients with an International Prostate Symptom Score (IPSS) of ≤7 were randomly assigned (1:1) to the tamsulosin group (0.2 mg/day orally for 7 days) (n = 47) or the control group (n = 47). The primary endpoint was the reinsertion rate of the urinary catheter after its removal on postoperative day (POD) 3. The secondary endpoints included the maximum (Qmax) and average (Qavg) urinary flow rates on POD 3, and the voided volume (VV), residual urine volume (RU), and IPSS on POD 7. Analyses were based on an intention-to-treat population. RESULTS The reinsertion rate of the urinary catheter in the tamsulosin group was similar to that in the control group (23.4 vs. 21.3 %, respectively; p = 0.804). The postoperative voiding parameters and IPSS were not better in the tamsulosin group than in the control group after adjustments were made for the baseline measurements with analysis of covariance (Qmax, p = 0.537; Qavg, p = 0.399; VV, p = 0.645; RU, p = 0.703; IPSS, p = 0.761). Multivariate analysis revealed that being male was the only independent risk factor for reinsertion of the urinary catheter (odds ratio 0.239; 95 % confidence interval 0.069-0.823; p = 0.023). CONCLUSIONS This controlled trial showed that tamsulosin at 0.2 mg/day does not prevent acute voiding difficulty after rectal cancer surgery.
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Kim JC, Yu CS, Lim SB, Kim CW, Kim JH, Kim TW. Abdominoperineal resection and low anterior resection: comparison of long-term oncologic outcome in matched patients with lower rectal cancer. Int J Colorectal Dis 2013; 28:493-501. [PMID: 23053680 DOI: 10.1007/s00384-012-1590-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE The current study aimed to compare the oncologic outcome and pattern of metastasis after abdominoperineal resection (APR) and low anterior resection (LAR) treating lower rectal cancer. METHODS A total of 804 patients undergoing curative resection (R0) were enrolled prospectively. The APR and LAR groups (n = 402, respectively) were matched for gender, age, and stage, for a retrospectively comparative analysis. RESULTS In a multivariate analysis with potential variables, APR itself was not a risk factor for increased local recurrence (LR) or reduced survival (P = 0.243-0.994). Circumferential resection margin (CRM) involvement as an operation-related risk was 1.6-fold more frequent in the APR group and was significantly associated with LR and systemic recurrence (OR, 2.487-4.017; P < 0.01). Circumferential margin positivity (CRM+) was concurrently correlated with advanced stage, larger tumor (long diameter, >4 cm), and longer sagittal midpelvic diameter (>10 cm) in a multivariate analysis (P < 0.001-0.05). The site of metastasis did not differ between the two groups, with the exception of lung metastasis which was more frequent in the APR group (APR vs. LAR: 15.9 vs. 10 %, P = 0.015). In the APR group, CRM+ and the presence of an infiltrating tumor were correlated with disease-free survival (hazard ratio (HR), 1.644 and 1.654, respectively), whereas elevated serum carcinoembryonic antigen and LVI+ were correlated with overall survival (HR, 1.57 and 1.671, respectively), in a multivariate analysis with potential variables (P < 0.05). CONCLUSIONS When performed with appropriate skill to achieve R0 resection, APR can be used safely without impairing oncological outcome, although sphincter-preserving surgery should remain the preferred option.
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Affiliation(s)
- Jin C Kim
- Department of Surgery, University of Ulsan College of Medicine, and Institute of Innovative Cancer Research, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, 138-736 Seoul, South Korea.
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Knowles G, Haigh R, McLean C, Phillips HA, Dunlop MG, Din FVN. Long term effect of surgery and radiotherapy for colorectal cancer on defecatory function and quality of life. Eur J Oncol Nurs 2013; 17:570-7. [PMID: 23453570 DOI: 10.1016/j.ejon.2013.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/13/2013] [Accepted: 01/22/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE Survival from rectal cancer has improved substantially. Understanding the consequences of treatment is important to optimise patient support and minimise impact on daily life. We aimed to define the long-term prevalence of pelvic dysfunction following curative rectal cancer surgery (+/- radiotherapy) within the context of overall quality of life. METHODS We evaluated bowel, urinary and sexual function and quality of life using three validated questionnaires in patients treated for rectal cancer. This group was compared to patients undergoing abdominal surgery without pelvic dissection for colon cancer during the same time period. RESULTS The response rate was 57% (381/667) with a median time interval of 4.4 years. A subset of rectal patients documented persistent problems with faecal leakage (16%); requiring to alter daily activities (18%); always needing to wear a protective pad (17%); rarely or never emptying their bowels fully (31%); difficulty controlling the passage of gas (32%) and requiring to modify diet (30%). Altered bowel function was found to impact on overall quality of life. Men reported increased erectile function difficulties. Pre-operative radiotherapy was associated with increased defecation problems as was low level of anastomosis (≤6 cm). CONCLUSION In keeping with emergent evidence, this study has quantified the extent of late adverse effects with a sub-set of rectal cancer patients reporting persistent bowel function problems. The implications are now to consider current follow-up services and to 'trial' new models of comprehensive assessment and interventions in patients who are 'at risk' of experiencing late adverse effects of treatment.
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Affiliation(s)
- Gillian Knowles
- Edinburgh Cancer Centre, Lothian University Hospitals Division, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, Scotland, UK.
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Loos M, Quentmeier P, Schuster T, Nitsche U, Gertler R, Keerl A, Kocher T, Friess H, Rosenberg R. Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol 2012; 20:1816-28. [PMID: 23269466 DOI: 10.1245/s10434-012-2827-z] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Preoperative radio(chemo)therapy (pR(C)T) significantly reduces the local recurrence risk and is therefore recommended in stage II/III rectal cancer. However, this multimodal treatment approach may be associated with late adverse effects. To determine the impact of pR(C)T on long-term anorectal, sexual, and urinary function, we performed a systematic review and meta-analysis. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for studies reporting on long-term functional outcome after rectal cancer resection with pR(C)T. Only studies that reported anorectal, sexual, and/or urinary function after rectal cancer resection in TME-technique with pR(C)T were eligible for inclusion. RESULTS Twenty-five studies, including 6,548 patients, were identified. Methodological quality of the eligible studies was low. The majority of studies reported higher rates of anorectal (14/18 studies) and male sexual dysfunction (9/10 studies) after pR(C)T. Few studies examined female sexual dysfunction (n = 4). Meta-analysis revealed that stool incontinence occurred more often in irradiated patients (risk ratio (RR) = 1.67; 95 % confidence interval (CI), 1.36, 2.05; p < 0.0001) and manometric results were significantly worse after pR(C)T (mean resting pressures (weighted mean difference (WMD) = 15.04; 95 % CI, 0.77, 29.31; p = 0.04) and maximum squeeze pressures (WMD = 30.39; 95 % CI, 21.48, 39.3; p < 0.0001)). Meta-analysis of erectile dysfunction revealed no statistical significance (RR = 1.41; 95 % CI, 0.74, 2.72; p = 0.3). Six of eight studies and meta-analysis demonstrated no negative effect of pR(C)T on urinary function (RR = 1.05; 95 % CI, 0.67, 1.65; p = 0.82). CONCLUSIONS Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME.
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Affiliation(s)
- Martin Loos
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany,
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Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2012; 12:CD004323. [PMID: 23235607 PMCID: PMC7197443 DOI: 10.1002/14651858.cd004323.pub4] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND For almost one hundred years abdominoperineal excision has been the standard treatment of choice for rectal cancer. With advances in the techniques for rectal resection and anastomosis, anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, except for those cancers very close to the anal sphincter. The main reason for this has been the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing an operation with a sphincter-preserving technique. However, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from stoma-patients. OBJECTIVES To compare the quality of life in rectal cancer patients with or without permanent colostomy. SEARCH METHODS We searched PUBMED, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Colorectal Cancer Group's specialised register. Abstract books from major gastroenterological and colorectal congresses were searched. Reference lists of the selected articles were scrutinized. SELECTION CRITERIA All controlled clinical trials and observational studies in which quality of life was measured in patients with rectal cancer having either abdominoperineal excision/Hartmann's operation or low anterior resection, using a validated quality of life instrument, were considered. DATA COLLECTION AND ANALYSIS One reviewer (JP) checked the titles and abstracts identified from the databases and hand search. Full text copies of all studies of possible relevance were obtained. The reviewer decided which studies met the inclusion criteria. Both reviewers independently extracted data. If information was insufficient the original author was contacted to obtain missing data. Extracted data were cross-checked and discrepancies resolved by consensus. MAIN RESULTS Sixty-nine potential studies were identified. Thirty-five of these, all non-randomised and representing 5127 participants met the inclusion criteria. Fourteen trials found that people undergoing abdominoperineal excision/Hartmann's operation did not have poorer quality of life measures than patients undergoing anterior resection. The rest of the studies found some difference, but not always in favour of non-stoma patients. Due to clinical heterogeneity and the fact that all studies were observational trials, meta-analysis of the included studies was not possible. AUTHORS' CONCLUSIONS The studies included in this review do not allow firm conclusions as to the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/Hartmann's operation. The included studies challenges the assumption that anterior resection patients fare better. Larger, better designed and executed prospective studies are needed to answer this question.
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Affiliation(s)
- Jørn Pachler
- Gastroenterology Unit, Hvidovre Hospital, Hvidovre, Denmark.
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Tennyson N, Mendenhall WM, Morris CG, Huang EH, Zlotecki RA. Transanal excision with radiation therapy for rectal adenocarcinoma. Clin Med Res 2012; 10:224-9. [PMID: 22997356 PMCID: PMC3494544 DOI: 10.3121/cmr.2012.1072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the efficacy of transanal excision (TAE) combined with radiotherapy for rectal adenocarcinoma, assess the ability of pretreatment endoscopic ultrasound (EUS) to predict failures, and determine the prognostic value of downstaging and complete pathological response. DESIGN Retrospective outcomes study. SETTING Radiation oncology clinic. PARTICIPANTS Thirty-eight patients with rectal adenocarcinoma. METHODS The medical records of patients treated with radiotherapy from 1998 to 2008 and followed for a median of 5.9 years were reviewed. RESULTS Kaplan-Meier estimates of freedom from selected endpoints at 5 years after treatment were: overall survival, 79%; cause-specific survival, 91%; local control, 90%; and freedom from distant metastasis, 76%. Seven patients (21%) had eventual abdominoperineal resection or lower anterior resection, four patients had local recurrence, and three patients had incomplete treatment or poor margins. T3 lesions clinically staged by EUS were a predictor of local failure (P=0.0110), but not distant metastasis (P=0.35). Patients with either a pathological or clinical T3 lesion did not have a significantly greater rate of metastasis (P=0.096). Patients who were downstaged did not have a significantly different rate of local recurrence or metastasis. Patients who experienced a complete pathological response did not have a significantly different rate of local control or distant metastasis. CONCLUSION Patients with early-stage rectal lesions who undergo preoperative or postoperative radiation and TAE have similar outcomes to those who undergo abdominoperineal resection; local recurrence was higher for patients with T3 lesions when both were compared. Abdominal surgery should be considered for these patients. TAE is reasonable when patients are unwilling or unable to tolerate the morbidity of traditional transabdominal surgery.
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Affiliation(s)
- Nathan Tennyson
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Emina H. Huang
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert A. Zlotecki
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
- Corresponding Author: Robert A. Zlotecki, MD, PhD; 2000 SW Archer Rd.; PO Box 100385; Gainesville, FL 32610-0385; Tel: (352) 265-0287; Fax: (352) 265-0759;
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Panjari M, Bell RJ, Burney S, Bell S, McMurrick PJ, Davis SR. Sexual function, incontinence, and wellbeing in women after rectal cancer--a review of the evidence. J Sex Med 2012; 9:2749-58. [PMID: 22905761 DOI: 10.1111/j.1743-6109.2012.02894.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the second most common cancer. One-third of these cancers occur in the rectum. Treatment of rectal cancer involves surgery with/without radiotherapy and chemotherapy. Surgery is undertaken to prevent damage to the nerves controlling bladder, bowel, and sexual organs, whether this translates into preservation of urinary and fecal continence and sexual function and, ultimately, quality of life (QoL) is not known. AIM The aim of this review was to summarize the literature regarding the impact of treatment for rectal cancer on bladder and bowel continence, sexual function and QoL in women. MAIN OUTCOME MEASURES A comprehensive review of the current literature on sexual function, incontinence and wellbeing in women after treatment for rectal cancer highlighting prevalence rates, trial design, and patient population. METHODS We conducted a systematic search of the literature using A systematic search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2011) for English-language studies that included the following search terms: "colorectal cancer," or "rectal cancer," or "rectal neoplasm," and "sexual function," or "sexual dysfunction," or "wellbeing," or "QoL," or "urinary or fecal incontinence." RESULTS Although around 1/3 of women aged 50 to 70 years report lack of sexual desire, sexual function problems after treatment for rectal cancer are in the order of 60% among women. QoL improves with length of survival. Urinary and fecal incontinence are ongoing concerns for many women after treatment with rates up to 60%. CONCLUSION There is a gap in our knowledge of the effects of rectal cancer and its treatment on urinary and fecal continence, sexual function and QoL in women. There is a need for studies of sufficient size and duration to gain a better understanding of the disease and its management and the long-term effects on these parameters. This information is needed to develop preventative health care plans for women treated for rectal cancer that target those most at risk for these adverse outcomes.
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Affiliation(s)
- Mary Panjari
- Women's Health Research Program, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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Traa MJ, De Vries J, Roukema JA, Den Oudsten BL. Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 2012; 23:19-27. [PMID: 21508174 DOI: 10.1093/annonc/mdr133] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To determine (i) the prevalence of sexual (dys)function in patients with colorectal cancer and (ii) treatment-related and sociodemographic aspects in relation to sexual (dys)function and the quality of sexual life. Recommendations for future studies are provided. METHODS A systematic search was conducted during the period 1990 to July 2010 that used the databases PubMed, PsychINFO, The Cochrane Library, EMBASE, and OVID Medline. RESULTS Eighty-two studies were included. The mean quality score was 7.2. The percentage of preoperatively potent men that experienced sexual dysfunction postoperatively varied from 5% to 88%. Approximately half of the women reported sexual dysfunction. Preoperative radiotherapy, a stoma, complications during or after surgery, and a higher age predicted more sexual dysfunction with a strong level of evidence. Type of surgery and a lower tumor location predicted more sexual dysfunction with a moderate level of evidence. Insufficient evidence existed for predictors of the quality of sexual life. Current studies mainly focus on biological aspects of sexual (dys)function. Furthermore, existing studies suffer from methodological shortcomings such as a cross-sectional design, a small sample size, and the use of nonstandardized measurements. CONCLUSION Sexuality should be investigated prospectively from a biopsychosocial model, hereby including the quality of sexual life.
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Affiliation(s)
- M J Traa
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - J De Vries
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Medical Psychology
| | - J A Roukema
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Surgery
| | - B L Den Oudsten
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Education and Research, St Elisabeth Hospital, Tilburg, The Netherlands.
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Late pelvic function following rectal cancer resection – a case-control study. Eur Surg 2011. [DOI: 10.1007/s10353-011-0036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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