Abstract

Background: The aim of the review is to assess the quality of life of patients with rectal cancer who underwent different surgical approaches such as abdominoperineal resection of the rectum (APR) and sphincter saving operations SSO (low anterior resection - LAR, intersphincteric resection - ISR) based on modern literature data.

Methods: The studies considering functional outcomes after APR and SSO and published over the last decade were randomly reviewed.

Results: The social, emotional, physical and cognitive abilities are impacted equally by both methods. The rate of specific functional outcomes after APR or SSO can be different depending on the anatomical features, stage of the disease, localization of the tumor in the rectum. The rate of sexual impairment fluctuates and tends to worsen in the patients after APR in some studies whereas SSO is quite often followed by LARS which significantly impaired QOL in 20 - 75% of the patients. In addition, APR impacted body image which causes dissatisfaction in 15 - 80% of patients and can be worse when the cultural issues are considered. Radiation therapy and chemotherapy may exacerbate various functional problems such as urogenital and sexual impairments of the patients after both surgical approaches. In addition, the experience of cancer by patients may temporarily mitigate the perception of the functional consequences with the first year after treatment. The patients must be informed about the consequences of SSO such as LARS and about that than those who would have a permanent stoma after APR may be surprised later on that their preoperative anxieties over the colostomy would not be turned into reality after treatment.

Conclusion: The long-term QOL of the patients with permanent stoma is equivalent to those with preserving anus for low rectal cancer.

Keywords: Rectal Cancer; Abdominoperineal Resection; Sphincter Saving Operations; Functional Outcomes; Quality of Life

References

1. Siegel RL., et al. “Cancer statistics, 2016”. CA: A Cancer Journal for Clinicians 66 (2016): 7-30.
2. Altobelli E., et al. “Colorectal cancer screening in countries of European Council outside of the EU-28”. World Journal of Gastroenterology 20 (2016): 4946-4957.
3. Ferlay J., et al. “Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012”. International Journal of Cancer 136 (2015): E359-E386.
4. Al Bandar MH., et al. “Comparison of trans-anal endoscopic operation and trans-anal excision of rectal tumors”. Annals of Medicine and Surgery 14 (2017): 18-24.
5. Allaix ME., et al. “Transanal endoscopic microsurgery for rectal cancer: T1 and beyond? An evidence-based review”. Surgical Endoscopy 11 (2016): 4841-4852.
6. Campos FG., et al. “Abdominoperineal excision: evolution of a centenary operation”. Diseases of the Colon and Rectum 8 (2012): 844-853.
7. Holm T. “Controversies in abdominoperineal excision”. Surgical Oncology Clinics of North America 1 (2014): 93-111.
8. Heald RJ., et al. “The mesorectum in rectal cancer surgery–the clue to pelvic recurrence?” British Journal of Surgery 10 (1982): 613-616.
9. MacFarlane JK., et al. “Mesorectal excision for rectal cancer”. Lancet 341 (1993): 457-4
10. Lundby L and Duelund-Jakobsen J. “Management of fecal incontinence after treatment for rectal cancer”. Current Opinion in Supportive and Palliative Care 1 (2011): 60-64.
11. Trenti L., et al. “Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: A cross-sectional study”. European Journal of Surgical Oncology 7 (2018): 1031-1039.
12. Silva MMRL., et al. “Late assessment of quality of life in patients with rectal carcinoma: comparison between sphincter preservation and definitive colostomy”. The International Journal of Colorectal Disease 8 (2018): 1039-1045.
13. Digennaro R., et al. “Coloanal anastomosis or abdominoperineal resection for very low rectal cancer: what will benefit, the surgeon's pride or the patient's quality of life?” The International Journal of Colorectal Disease 7 (2013): 949-957.
14. Gervaz P., et al. “A Prospective longitudinal evaluation of quality of life after abdominoperineal resection”. Journal of Surgical Oncology 1 (2008): 14-19.
15. Wang XT., et al. “Meta-Analysis of Oncological Outcome After Abdominoperineal Resection or Low Anterior Resection for Lower Rectal Cancer Pathol”. Oncology Research 21 (2015): 19-27.
16. Chambers W., et al. “Examination of outcome following abdominoperineal resection for adenocarcinoma in Oxford”. Colorectal Dis12 (2010): 1192-1197.
17. Law WL and Chu KW. “Impact of total mesorectal excision on the results of surgery od distal rectal cancer”. British Journal of Surgery 88 (2001): 1607-1612.
18. Honda M., et al. “Patient-centered outcomes to decide treatment strategy for patients with low rectal cancer”. Journal of Surgical Oncology 5 (2016): 630-636.
19. Kasparek MS., et al. “Quality of life after coloanal anastomosis and abdominoperineal resection for distal rectal cancers: sphincter preservation vs quality of life”. Colorectal Disease 8 (2011): 872-877.
20. Cornish JA., et al. “A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer”. Annals of Surgical Oncology 7 (2007): 2056-2068.
21. Konanz J., et al. “Quality of life of patients after low anterior, intersphincteric, and abdominoperineal resection for rectal cancer--a matched-pair analysis”. The International Journal of Colorectal Disease 5 (2013): 679-688.
22. Russell MM., et al. “Comparative effectiveness of sphincter-sparing surgery versus abdominoperineal resection in rectal cancer: patient-reported outcomes in National Surgical Adjuvant Breast and Bowel Project randomized trial R-04”. Annals of Surgery 1 (2015): 144-148.