Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer

Abstract

PURPOSE:Issues related to body image and a permanent stoma after abdominoperineal resection may decrease quality of life in rectal cancer patients. However, specific problems associated with a low anastomosis may similarly affect quality of life for patients undergoing low anterior resection. The aim of this study was to compare quality of life of low rectal cancer patients after undergoing abdominoperineal resection versus low anterior resection.METHODS:Demographics, tumor and treatment characteristics, and prospectively collected preoperative quality-of-life data for patients undergoing low anterior resection or abdominoperineal resection for low rectal cancer between 1995 and 2009 were compared. Quality of life collected at specific time intervals was compared for the two groups, adjusting for age, body mass index, use of chemoradiation, and 30 days postoperative complications. The short-form-36 questionnaire was used to determine quality of life.RESULTS:The query returned 153 patients (abdominoperineal resection = 68, low anterior resection = 85) with a median follow-up of 24 (3-64) mo. The after abdominoperineal resection group had a higher mean age (63 ± 12 vs. 54 ± 12, p < 0.001) and more American Society of Anesthesiologists classification 3/4 patients (65 percent vs. 43 percent, p = 0.03) than low anterior resection. Other demographics, tumor stage, use of chemoradiation, overall postoperative complication rates, and quality-of-life follow-up time were not statistically different in both groups. Patients undergoing abdominoperineal resection had a lower baseline short-form-36 mental component score than those undergoing low anterior resection. However, 6 mo after surgery this difference was no longer statistically significant and essentially disappeared at 36 mo after surgery.CONCLUSION:Patients undergoing abdominoperineal resection for low rectal cancer have a similar long-term quality of life as those undergoing low anterior resection. These findings can help clinicians to better counsel patients with low rectal cancer who are being considered for abdominoperineal resection.

Abdominoperineal Resection in Rectal Cancer in General Surgery Department at Gabriel Toure University Hospital

“…In our study, 14 out of 17 patients (82.4%) had TNM III stage cancer. This rate is significantly higher than those observed in western series (10% to 39%) [22] [23]. This could be explained by the delay of consultation in our series.…”

“…In France, 42,152 new cases of colorectal cancer were estimated in 2012 (23,226 men and 1826 women) with 1772 deaths [5]. In the USA 143,460 new cases of colorectal cancer with 51,690 deaths were estimated in 2012 [6].…”

Functioning of people with colorectal cancer during chemotherapy. Demographic and clinical determinants of quality of life of patients with colorectal cancer receiving chemotherapy. Pilot study

“…Another important determinant is the presence of intestinal stoma which, according to our own and other authors' research, has a negative impact on quality of life (De Campos-Lobato, Alves Ferreira, Lavery, & Kira, 2001;Smith-Gagen et al, 2010). Especially women worse tolerate the presence of a stoma both mentally and physically.…”

Extralevator AbdominoPerineal Excision (ELAPE) for Advanced Low Rectal Cancer

“…' A 2007 Meta analysis [56] confirmed these initial findings, that there was no difference in the quality of life experienced following APE or low anterior resection. This has been further supported by data published from the Cleveland clinic in 2011, which used validated QOL questionnaires to follow up rectal cancer survivors and found that there was no difference between those with a permanent stoma and those without [57].…”