Skip to main content

Advertisement

SpringerLink
Log in

Quality of life of patients after low anterior, intersphincteric, and abdominoperineal resection for rectal cancer—a matched-pair analysis

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Limits for sphincter preservation in rectal cancer have been expanded under the assumption that patients with a permanent colostomy have worse quality of life (QoL). Incontinence and painful defecation are common problems; therefore, this study compares functional outcome and QoL after sphincter-sparing intersphincteric resection (ISR), low anterior resection (LAR), and abdominoperineal resection (APR) for rectal cancer.

Methods

From a prospective database, three matched groups of patients after surgery for rectal cancer between 1999 and 2009 were extracted. Median follow-up was 59 months. Of 131 patients receiving a questionnaire, 95 % could be analyzed further. Generic and disease-specific validated QoL (European Organization for Research and Treatment in Cancer QLQ-C30, CR38) and Wexner incontinence score were used.

Results

Global QoL was comparable between the groups. Physical functioning was significantly better after sphincter preservation surgery than APR (p < 0.05). Symptom scores for diarrhea (DIA) and constipation (CON) were higher after sphincter-preserving surgery (ISR: DIA 45.4, CON 20.2; LAR: DIA 34.1, CON 25.2) compared to APR (DIA 16.6, CON 12.0) (p < 0.05 and <0.01, respectively). Disease-specific QoL assessment showed significantly worse QoL regarding to male sexual function after APR (80.8) than after ISR (53.6) (p < 0.005). Regarding defecation, the ISR group showed significantly higher symptom scores than patients after LAR (p < 0.05). Wexner scores were significantly higher after ISR (12.9) than after LAR (9.5) (p < 0.005).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Weitz J et al (2005) Colorectal cancer. Lancet 365(9454):153–65

    Article  PubMed  Google Scholar 

  2. National Comprehensive Cancer Network (2012) NCCN Guidelines—rectal cancer version 2.2012. NCCN Clinical Practice Guidelines in Oncology, 09.12.2012

  3. Wilson TR, Alexander DJ (2008) Clinical and non-clinical factors influencing postoperative health-related quality of life in patients with colorectal cancer. Br J Surg 95(11):1408–15

    Article  PubMed  CAS  Google Scholar 

  4. Engel J et al (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238(2):203–13

    PubMed  Google Scholar 

  5. Hohenberger W et al (2006) The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis 8(1):23–33

    Article  PubMed  CAS  Google Scholar 

  6. Ho VP et al (2011) Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum 54(1):113–25

    Article  PubMed  Google Scholar 

  7. Hassan I et al (2006) Long-term functional and quality of life outcomes after coloanal anastomosis for distal rectal cancer. Dis Colon Rectum 49(9):1266–74

    Article  PubMed  Google Scholar 

  8. Hassan I, Cima RR (2007) Quality of life after rectal resection and multimodality therapy. J Surg Oncol 96(8):684–92

    Article  PubMed  Google Scholar 

  9. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341(8843):457–60

    Article  PubMed  CAS  Google Scholar 

  10. Fayers PM, Aaronson NK, on behalf of the EORTC Quality of Life Group et al (2001) The EORTC QLQ-C30 Scoring Manual. European Organization for Research and Treatment of Cancer, Brussels

    Google Scholar 

  11. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97

    Article  PubMed  CAS  Google Scholar 

  12. Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37(11):1345–51

    Article  PubMed  CAS  Google Scholar 

  13. Hayashi T, Murakami M, Era S (2009) Preliminary study of modification of serum albumin through paracellular pathway of rat submandibular gland. J Med Invest 56(Suppl):393–4

    Article  PubMed  Google Scholar 

  14. Allal AS et al (2000) Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 82(6):1131–7

    Article  PubMed  CAS  Google Scholar 

  15. Kiran RP, Lian L, Lavery IC (2011) Does a subcentimeter distal resection margin adversely influence oncologic outcomes in patients with rectal cancer undergoing restorative proctectomy? Dis Colon Rectum 54(2):157–63

    Article  PubMed  Google Scholar 

  16. Bujko K, et al (2011) Is the 1-cm Rule of Distal Bowel Resection Margin in Rectal Cancer Based on Clinical Evidence? A Systematic Review. Ann Surg Oncol

  17. Bretagnol F et al (2004) Long-term functional results after sphincter-saving resection for rectal cancer. Gastroenterol Clin Biol 28(2):155–9

    Article  PubMed  Google Scholar 

  18. Ortiz H, Armendariz P (1996) Anterior resection: do the patients perceive any clinical benefit? Int J Colorectal Dis 11(4):191–5

    Article  PubMed  CAS  Google Scholar 

  19. Kakodkar R, Gupta S, Nundy S (2006) Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome. Colorectal Dis 8(8):650–6

    Article  PubMed  CAS  Google Scholar 

  20. Camilleri-Brennan J, Steele RJ (2002) Objective assessment of morbidity and quality of life after surgery for low rectal cancer. Colorectal Dis 4(1):61–66

    Article  PubMed  Google Scholar 

  21. Vironen JH et al (2006) Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum 49(5):568–78

    Article  PubMed  Google Scholar 

  22. Pachler J, Wille-Jorgensen P (2005) Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2:CD004323

    PubMed  Google Scholar 

  23. Cornish JA et al (2007) A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Ann Surg Oncol 14(7):2056–68

    Article  PubMed  Google Scholar 

  24. Kasparek MS et al (2011) Quality of life after coloanal anastomosis and abdominoperineal resection for distal rectal cancers: sphincter preservation vs quality of life. Colorectal Dis 13(8):872–7

    Article  PubMed  CAS  Google Scholar 

  25. Tsunoda A et al (2008) Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum 51(2):218–22

    Article  PubMed  Google Scholar 

  26. Hida J, Okuno K (2010) Pouch operation for rectal cancer. Surg Today 40(4):307–14

    Article  PubMed  Google Scholar 

  27. Kuo LJ, et al (2011) Oncological and Functional Outcomes of Intersphincteric Resection for Low Rectal Cancer. J Surg Res

  28. Schmidt C et al (2010) Sexual impairment and its effects on quality of life in patients with rectal cancer. Dtsch Arztebl Int 107(8):123–30

    PubMed  Google Scholar 

  29. Palmer G et al (2008) Quality of life after potentially curative treatment for locally advanced rectal cancer. Ann Surg Oncol 15(11):3109–17

    Article  PubMed  Google Scholar 

  30. Havenga K et al (1996) Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 182(6):495–502

    PubMed  CAS  Google Scholar 

  31. Moszkowicz D et al (2011) Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis 13(12):1326–34

    Article  PubMed  CAS  Google Scholar 

  32. Ogata Y et al (2009) Elevated preoperative serum carcinoembrionic antigen level may be an effective indicator for needing adjuvant chemotherapy after potentially curative resection of stage II colon cancer. J Surg Oncol 99(1):65–70

    Article  PubMed  Google Scholar 

  33. Barisic G et al (2011) Function after intersphincteric resection for low rectal cancer and its influence on quality of life. Colorectal Dis 13(6):638–43

    Article  PubMed  CAS  Google Scholar 

  34. Ito N et al (2010) Response shift in quality-of-life assessment in patients undergoing curative surgery with permanent colostomy: a preliminary study. Gastroenterol Nurs 33(6):408–12

    Article  PubMed  Google Scholar 

  35. Schwartz CE et al (2006) The clinical significance of adaptation to changing health: a meta-analysis of response shift. Qual Life Res 15(9):1533–50

    Article  PubMed  Google Scholar 

  36. Rauch P et al (2004) Quality of life among disease-free survivors of rectal cancer. J Clin Oncol 22(2):354–60

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany

    Julia Konanz, Florian Herrle, Stefan Post & Peter Kienle

  2. Institute of Medical Statistics and Biometry, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany

    Christel Weiss

Authors
  1. Julia Konanz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florian Herrle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christel Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Post
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Kienle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julia Konanz.

Additional information

Julia Konanz and Florian Herrle are equal first author.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Konanz, J., Herrle, F., Weiss, C. et al. Quality of life of patients after low anterior, intersphincteric, and abdominoperineal resection for rectal cancer—a matched-pair analysis. Int J Colorectal Dis 28, 679–688 (2013). https://doi.org/10.1007/s00384-013-1683-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1683-z

Keywords

Search

Navigation