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Long-term Outcomes After Surgery Involving the Pelvic Floor in Rectal Cancer: Physical Activity, Quality of Life, and Health Status

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

This study has aimed to evaluate the effects of surgery on physical activity (PA), quality of life (QoL), and disease-specific health status, by analyzing the differences between sphincter-preserving surgery (low anterior resection (LAR)) and abdominoperineal resection (APR) among rectal cancer survivors.

Methods

Individuals who were diagnosed with rectal cancer and who underwent an APR or a LAR between 2000 and 2009 were included. The different questionnaires on QoL, disease-specific health status, and physical activity began their surveys in 2010. Differences in QoL, health status, and physical activity were analyzed between the APR group and the LAR group.

Results

The study included 905 rectal cancer survivors (LAR, 632; APR, 273). Besides a higher rate of radiotherapy treatment in the APR group (94% vs. 75%, p < 0.001), there were no differences in clinical characteristics or in comorbid conditions between the LAR group and APR group. No significant differences were found in PA level between the patients who had undergone an APR vs. a LAR. Regarding QoL, APR patients did report a worse physical (p = 0.009) and role functioning (p = 0.03), as well as a worse body image (p = 0.001), compared to patients who had undergone a LAR. However, they reported fewer constipation (p = 0.02) and gastrointestinal problems (p = 0.009). Finally, compared to patients who had undergone a LAR with a permanent ostomy, APR patients reported a better body image (p = 0.048) and less stoma-related problems (p = 0.001).

Conclusions

This study showed no differences in PA level among the patients who had undergone an APR versus a LAR. With respect to their QoL, their physical and role functioning seemed to be worse in the APR patients. However, these differences in outcomes resolved when comparing the APR group with patients after a LAR with a permanent ostomy.

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Abbreviations

APR:

Abdominoperineal resection

ECR:

Eindhoven Cancer Registry

EORTC QLQ-C30:

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire

QoL:

Quality of life

LAR:

Low anterior resection

LARS:

Low anterior resection syndrome

LMM:

Linear mixed models

PROFILES:

Patient Reported Outcomes Following Initial Treatment and Long Term Evaluations of Survivorship

PA:

Physical activity

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Acknowledgements

The researchers would like to thank all of the patients and their doctors for their participation in this study. A special thanks goes to Dr. M. van Bommel, who was willing to function as an independent advisor and to answer the questions of the patients. In addition, the researchers want to thank the following hospitals for their cooperation: Amphia Hospital, Breda; the Bernhoven Hospitals in Veghel and Oss; Catharina Hospital, Eindhoven; Elkerliek Hospital, Helmond; Jeroen Bosch Hospital, ‘s-Hertogenbosch; the Máxima Medical Centers in Eindhoven and Veldhoven; Sint Anna Hospital, Geldrop; Elisabeth – TweeSteden Hospital, Tilburg; and the VieCury Hospitals in Venlo and Venray..

Financial Support

The data collection for this study was funded by a VENI Grant (no. 451-10-041) from the Netherlands Organization for Scientific Research (The Hague, The Netherlands) awarded to Floortje Mols, together with a Medium Investment Grant from the Netherlands Organization for Scientific Research (The Hague, The Netherlands, NWO No. 480-08-009).

Dr. Dounya Schoormans (No. UVT2013-5893) was supported by a Social Psychology Fellowship from the Dutch Cancer Society, Amsterdam, The Netherlands.

These funding agencies had no further role in the study’s design; in the collection, the analyses and the interpretation of the data; in the writing of the paper; and in the decision to submit this paper for publication.

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Authors and Affiliations

  1. Department of Surgery, Elisabeth – TweeSteden Hospital, Dr. Deelenlaan 5, 5042AD, Tilburg, The Netherlands

    Tijmen Koëter, Ingrid S. Martijnse, Barbara S. Langenhoff, David D. E. Zimmerman & Daria K. Wasowicz

  2. CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

    Cynthia S. Bonhof, Dounya Schoormans & Floortje Mols

  3. Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands

    Floortje Mols

Authors
  1. Tijmen Koëter
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  2. Cynthia S. Bonhof
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  3. Dounya Schoormans
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  4. Ingrid S. Martijnse
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  5. Barbara S. Langenhoff
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  6. David D. E. Zimmerman
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  7. Floortje Mols
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  8. Daria K. Wasowicz
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Corresponding author

Correspondence to Daria K. Wasowicz.

Ethics declarations

This study was approved by a local Dutch Certified Medical Ethics Committee. All of the patients gave their informed consent. The manuscript has been prepared in accordance with the style of the journal and all of the authors have approved its contents. This manuscript is not being considered for publication elsewhere and the findings in this manuscript have not been previously published.

Conflict of Interest

The authors declare that there is no conflict of interest.

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Koëter, T., Bonhof, C.S., Schoormans, D. et al. Long-term Outcomes After Surgery Involving the Pelvic Floor in Rectal Cancer: Physical Activity, Quality of Life, and Health Status. J Gastrointest Surg 23, 808–817 (2019). https://doi.org/10.1007/s11605-018-4014-4

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  • DOI: https://doi.org/10.1007/s11605-018-4014-4

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