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Quality of Life After Total Mesorectal Excision and Rectal Replacement: Comparing Side-to-End, Colon J-Pouch and Straight Colorectal Reconstruction in a Randomized, Phase III Trial (SAKK 40/04)

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Abstract

Background

Functional outcomes of different reconstruction techniques have an impact on patients’ quality of life (QoL), but information on long-term QoL is lacking. We compared QoL among three reconstruction techniques after total mesorectal excision (TME).

Methods

Quality of life was assessed within a randomized, multicenter trial comparing rectal surgery using side-to-end anastomosis (SEA), colon J-pouch (CJP), and straight colorectal anastomosis (SCA) by the Functional Assessment of Cancer Therapy-Colorectal scale (FACT-C) before randomization and every 6 months up to 2 years post-TME. The primary QoL endpoint was the change in the Trial Outcome Index (TOI), including the FACT-C subscales of physical and functional well-being and colorectal cancer symptoms (CSS), from baseline to month 12. Pair-wise comparisons of changes from baseline (presurgery) to each timepoint between the three arms were analyzed by Mann–Whitney tests.

Results

For the QoL analysis, 257 of 336 randomized patients were in the per protocol evaluation (SEA = 95; CJP = 63; SCA = 99). Significant differences between the reconstruction techniques were found for selected QoL scales up to 12 months, all in favor of CJP. Patients with SEA or SCA reported a clinically relevant deterioration for TOI and CSS at 6 months, those with SCA for CSS also at 12 months after TME. Patients with CJP remained stable.

Conclusions

Although the three reconstruction techniques differ in their effects on QoL at months 6 and 12, these differences did not persist over the whole observation period of 24 months. Patients with a colon J-pouch may benefit with respect to QoL in the short-term.

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Acknowledgment

This work was partially supported by a grant from Oncosuisse (OCS 01579-08-2004) and by the Swiss State Secretariat for Education, Research and Innovation (SERI).

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Authors and Affiliations

  1. International Breast Cancer Study Group (IBCSG) Coordinating Center, Bern, Switzerland

    Karin Ribi PhD & Jürg Bernhard PhD

  2. Kantonsspital Aarau now at chirurgieaarau, Aarau, Switzerland

    Walter R. Marti MD & Gaudenz Curti MD

  3. Bern University Hospital, Inselspital, Bern, Switzerland

    Jürg Bernhard PhD & Beat Gloor MD

  4. Kantonsspital Winterthur, Winterthur, Switzerland

    Felix Grieder MD

  5. Luzerner Kantonsspital now at Spital Muensterlingen, Muensterlingen, Switzerland

    Michael Graf MD

  6. Kantonsspital Solothurn, Solothurn, Switzerland

    Markus Zuber MD

  7. Centre hospitalier universitaire vaudoise, Lausanne, Switzerland

    Nicolas Demartines MD

  8. SAKK Coordinating Center, Bern, Switzerland

    Karin Ribi PhD, Christiane Andrieu PhD, Martin Bigler MSc & Stefanie Hayoz PhD

  9. Zürich Hirslandenklinik, Zurich, Switzerland

    Heinz Wehrli MD

  10. Universitätsspital Basel, Basel, Switzerland

    Christoph Kettelhack MD

  11. Kantonsspital Zug, Baar, Switzerland

    Bruno Lerf MD

  12. Ospedale regionale di Mendrisio Beata Vergine, Mendrisio, Switzerland

    Fabrizio Fasolini MD

  13. Kreiskliniken Lörrach, Lörrach, Germany

    Christian Hamel MD

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  1. Karin Ribi PhD
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  2. Walter R. Marti MD
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  13. Heinz Wehrli MD
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For the Swiss group for clinical cancer research, section surgery

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Correspondence to Karin Ribi PhD.

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Ribi, K., Marti, W.R., Bernhard, J. et al. Quality of Life After Total Mesorectal Excision and Rectal Replacement: Comparing Side-to-End, Colon J-Pouch and Straight Colorectal Reconstruction in a Randomized, Phase III Trial (SAKK 40/04). Ann Surg Oncol 26, 3568–3576 (2019). https://doi.org/10.1245/s10434-019-07525-2

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