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Clin Colon Rectal Surg 2002; 15(1): 087-092
DOI: 10.1055/s-2002-23572
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Quality of Life Following Rectal Cancer Resection: Pros and Cons of Sphincter Preservation

Barbara Del Frari1 , Joerg Tschmelitsch2
  • 1Department of Surgery, University of Innsbruck
  • 2Department of Surgery, KH der Barmherzigen Brueder St. Veit, Austria
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Publikationsdatum:
03. April 2002 (online)

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ABSTRACT

It is evident that surgery for rectal cancer has an important impact on a patient's quality of life.

In recent years, due to a change in philosophy regarding the distal margin plus the introduction of circular stapling devices, a sphincter-sparing resection has become feasible in most patients with rectal cancer.

As shown in numerous studies, ultralow anterior resections or intersphincteric resections with a coloanal anastomosis for rectal cancer do not compromise oncologic results compared with an abdominoperineal resection. Recently, with an increasing number of sphincter-saving procedures, reduced mortality and operative morbidity, and local recurrence rates, a change in assessing outcome has become apparent. While overall survival and local recurrence rates remain the primary concern, both patients and surgeons are interested in long-term functional results and quality of life. A vast body of literature suggests that patients who have a colostomy have a worse quality of life than those without a stoma; however, few studies measured global quality of life prospectively, using a well-researched questionnaire.

The aim of this article is to discuss the available literature and our own results regarding quality of life following sphincter-sparing surgery and abdominoperineal excision for rectal cancer.

KEYWORD

Rectal cancer - sphincter preservation - quality of life

REFERENCES

  • 1 Grumann M M, Noack E M, Hoffmann I A, Schlag P M. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer.  Ann Surg . 2001;  233 149-156
    CrossrefPubMedSuche in Google Scholar
  • 2 Karanjia N D, Schache D J, Heald R J. Function of the distal rectum after low anterior resection for carcinoma.  Br J Surg . 1992;  79 114-116
    CrossrefPubMedSuche in Google Scholar
  • 3 Jehle E C, Haehnel T, Starlinger M J, Becker H D. Level of the anastomosis does not influence functional outcome after anterior resection for rectal cancer.  Am J Surg . 1995;  169 147-152
    CrossrefPubMedSuche in Google Scholar
  • 4 Hallböök O, Sjödahl R. Anastomotic leakage and functional outcome after anterior resection of the rectum.  Br J Surg . 1996;  83 60-62
    CrossrefPubMedSuche in Google Scholar
  • 5 Nesbakken A, Nygaard K, Lunde O C. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer.  Br J Surg . 2001;  88 400-404
    CrossrefPubMedSuche in Google Scholar
  • 6 Lewis W G, Williamson M ER, Kuzu A. Potential disadvantages of post-operative adjuvant radiotherapy after anterior resection for rectal cancer: a pilot study of sphincter function, rectal capacity and clinical outcome.  Int J Colorectal Dis . 1995;  10 133-137
    CrossrefPubMedSuche in Google Scholar
  • 7 Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum.  Br J Surg . 1986;  73 136-138
    CrossrefPubMedSuche in Google Scholar
  • 8 Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma.  Br J Surg . 1986;  73 139-141
    PubMedSuche in Google Scholar
  • 9 Hallböök O, Pahlman L, Krog M, Wexner S D, Sjödhal R. Randomized comparison of straight and colonic J-pouch anastomosis after low anterior resection.  Ann Surg . 1996;  224 58-65
    CrossrefPubMedSuche in Google Scholar
  • 10 Ho Y H, Tan M, Seow-Choen F. Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J-pouch anastomosis.  Br J Surg . 1996;  83 978-980
    PubMedSuche in Google Scholar
  • 11 Huber F T, Siewert J R. Colonic pouch versus side-to-end anastomosis in low anterior resection.  Dis Colon Rectum. 1999;  42 896-902
    CrossrefPubMedSuche in Google Scholar
  • 12 Lazorthes F, Chiotasso P, Gamagami R, Istvan G, Chevreau P. Late clinical outcome in a randomized prospective comparison of colonic pouch and straight coloanal anastomosis.  Br J Surg . 1997;  84 1449-1451
    CrossrefPubMedSuche in Google Scholar
  • 13 Seow-Choen F, Goh H S. Prospective randomized trial comparing J-colonic pouch-anal anastomosis and straight coloanal reconstruction.  Br J Surg . 1995;  82 608-610
    CrossrefPubMedSuche in Google Scholar
  • 14 Hida J, Yasutomi M, Fujimoto K. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch.  Dis Colon Rectum . 1996;  39 986-991
    CrossrefPubMedSuche in Google Scholar
  • 15 Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S. Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis.  Dis Colon Rectum . 1997;  40 1409-1413
    PubMedSuche in Google Scholar
  • 16 Hida J, Yasutomi M, Maruyama T. Indications for colonic J-pouch reconstruction after anterior resection for rectal cancer. Determining the optimum level of anastomosis.  Dis Colon Rectum . 1998;  41 558-563
    PubMedSuche in Google Scholar
  • 17 Teramoto T, Watanabe M, Kitajima M. Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer.  Dis Colon Rectum . 1997;  40(suppl) S43-S47
    PubMedSuche in Google Scholar
  • 18 Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours.  Br J Surg . 1994;  81 1376-1378
    CrossrefPubMedSuche in Google Scholar
  • 19 Rullier E, Zerbib F, Laurent C. Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer.  Dis Colon Rectum . 1999;  42 1168-1175
    PubMedSuche in Google Scholar
  • 20 Gamagami R, Istvan G, Cabarrot P, Liagre A, Chiotasso P, Lazorthes F. Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomoses.  Surgery . 2000;  127 291-295
    CrossrefPubMedSuche in Google Scholar
  • 21 Berger A, Tiret E, Cunningham C, Dehni N, Parc R. Rectal excision and colonic pouch-anal anastomosis for rectal cancer. Oncologic results at five years.  Dis Colon Rectum . 1999;  42 1265-1271
    PubMedSuche in Google Scholar
  • 22 Cavaliere F, Pemberton J H, Cosimelli M, Fazio V W, Beart R W. Coloanal anastomosis for rectal cancer.  Dis Colon Rectum . 1995;  38 807-812
    PubMedSuche in Google Scholar
  • 23 Gamagami R A, Liagre A, Chiotasso P, Istvan G, Lazorthes F. Coloanal anastomosis for distal third rectal cancer. Prospective study of oncologic results.  Dis Colon Rectum . 1999;  42 1272-1275
    PubMedSuche in Google Scholar
  • 24 Paty P B, Enker W E, Cohen A M, Lauwers G Y. Treatment of rectal cancer by low anterior resection with coloanal anastomosis.  Ann Surg . 1994;  219 365-373
    CrossrefPubMedSuche in Google Scholar
  • 25 Sprangers M AG, Taal B G, Aaronson N K, te Velde A. Quality of life in colorectal cancer. Stoma versus nonstoma patients.  Dis Colon Rectum . 1995;  38 361-369
    PubMedSuche in Google Scholar
  • 26 Grumann M M, Noack E M, Hoffmann I A, Schlag P M. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer.  Ann Surg . 2001;  233 149-156
    CrossrefPubMedSuche in Google Scholar
  • 27 Hallböök O, Hass U, Wanstrom A, Sjödahl R. Quality of life measurement after rectal excision for cancer. Comparison between straight and colonic J-pouch anastomosis.  Scand J Gastroenterol . 1997;  32 490-493
    PubMedSuche in Google Scholar
  • 28 Whynes D K, Neilson A R, Robinson M HE, Hardcastle J D. Colorectal cancer screening and quality of life.  Qual Life Res . 1994;  3 191-198
    CrossrefPubMedSuche in Google Scholar
  • 29 Whynes D K, Neilson A R. Symptoms before and after surgery for colorectal cancer.  Qual Life Res . 1997;  6 61-66
    PubMedSuche in Google Scholar
  • 30 Camillieri-Brennan J, Steele J C. Quality of life after treatment for rectal cancer.  Br J Surg . 1998;  85 1036-1043
    CrossrefPubMedSuche in Google Scholar
  • 31 Hunt S M, McKenna S P, McEwen J. The Nottingham Health Profile: subjective health status medical consultations.  Soc Sci Med . 1981;  15A 221-229
    PubMedSuche in Google Scholar
  • 32 Cella D F, Tulsky D S, Gray G. The functional assessment of cancer therapy scale: development and validation of the general measure.  J Clin Oncol . 1984;  2 472-483
    PubMedSuche in Google Scholar
  • 33 Aaronson N K, Ahmedzai S, Bergman B. The EORTC QLQ-C30: a quality of life instrument for use in international clinical trials in oncology.  J Natl Cancer Inst . 1993;  85 365-376
    CrossrefPubMedSuche in Google Scholar
  • 34 Wagman R, Minsky B D, Cohen A M, Guillem J G, Paty P P. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long-term follow-up.  Int J Radiat Oncol Biol Phys . 1998;  42 51-57
    CrossrefPubMedSuche in Google Scholar
  • 35 Birnbaum E H, Myerson R J, Fry R D, Kodner I J, Fleshman J W. Chronic effects of pelvic radiation therapy on anorectal function.  Dis Colon Rectum . 1994;  37 909-915
    PubMedSuche in Google Scholar
  • 36 Kollmorgen C F, Meagher A P, Wolff B G, Pemberton J H, Martenson J A, Illstrup D M. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal cancer on bowel function.  Ann Surg . 1994;  220 676-682
    CrossrefPubMedSuche in Google Scholar
  • 37 Renner K, Rosen H R, Novi G, Hölbling N, Schiessel R. Quality of life after surgery for rectal cancer. Do we still need a permanent colostomy?.  Dis Colon Rectum . 1999;  42 1160-116
    PubMedSuche in Google Scholar