Coloanal anastomosis or abdominoperineal resection for very low rectal cancer: what will benefit, the surgeon's pride or the patient's quality of life?
- 820 Downloads
Sphincter-saving operation with coloanal anastomosis (CAA) has become an established option for very low rectal cancer, but few studies have compared its functional results and quality of life (QoL) with abdominoperineal resection (APR) showing controversial results.
Patients and methods
Patients treated for low rectal cancer with APR or CAA, disease-free after a median follow-up period of 26.5 (8–84) and 52.5 (12–156) months, respectively, were retrospectively reviewed. General and disease-specific changes in QoL and severity of disease were evaluated by Karnofsky scale, EORTC-C30, EORTC-CR38, SF-36, PGWBI, FIQL, PAC-QoL, ICIQ-SF, Stoma-QoL, AMS, Wexner's score and obstructed defecation syndrome (ODS) score.
Twenty-six APR patients and 34 CAA patients entered the study. Karnofsky score did not show significant differences. The median Stoma-QoL was 58.2 (45–76.6), indicating a good stoma function in 95 % of patients. EORTC-C30, CR38, PGWBI and SF-36 questionnaires did not show significant differences between the two groups except for sexual function (better after CAA, p = 0.01). Eleven patients after APR and eight after CAA had urinary incontinence, and its severity did not differ significantly. Eighteen of 21 CAA patients complained of faecal incontinence [AMS, 80 (15–120); Wexner, 13 (2–19)] with an impact on their QoL [FIQL: lifestyle, 1.75 (0–4); coping/behaviour, 1.3 (0–3.5); depression, 2.1 (0–5.2); embarrassment, 2 (0–4.6)] and 11 complained of obstructed defecation [7.5 (3–16)] with significant consequences on QoL [PAC-QoL, 30.4 (19.2–80.3)].
QoL in patients with permanent stoma and in those after CAA did not differ significantly. APR patients had worse sexual function, while most CAA patients had faecal incontinence and sometime obstructed defecation, with important impact on their QoL.
KeywordsColoanal anastomosis Abdominoperineal resection Rectal cancer
- 13.Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 3(85):365–376. doi: 10.1093/jnci/85.5.365 CrossRefGoogle Scholar
- 14.Sprangers MA, te Velde A, Aaronson NK (1999) The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer 35:238–247PubMedCrossRefGoogle Scholar
- 15.Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, p 196Google Scholar
- 16.Dupuy HJ (1984) The psychological general well-being (PGWB) index. In: Wenger NK, Mattson ME, Furberg CD, Elinson J (eds) Assessment of quality of life in clinical trials of cardiovascular therapies, Chap. 9. Le Jacq Publishing, New York, pp 170–183Google Scholar
- 20.Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, Guillem JG, Minsky BD, Kalman M, Thaler HT, Schrag D, Wong WD (2005) The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 48:1353–1365. doi: 10.1007/s10350-004-0942-z PubMedCrossRefGoogle Scholar
- 22.American Medical Systems (1996) Fecal incontinence scoring system. American Medical Systems, MinnetonkaGoogle Scholar
- 40.How P, Stelzner S, Branagan G, Bundy K, Chandrakumaran K, Heald RJ, Moran B (2012) Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer. Dis Colon Rectum 55:400–406. doi: 10.1097/DCR.0b013e3182444fd1 PubMedCrossRefGoogle Scholar