Anorectal Function and Quality of Life in Patients With Early Stage Rectal Cancer Treated With Chemoradiation and Local Excision

Abstract

Background Little is known about anorectal function and quality of life after chemoradiation followed by local excision, which is an alternative to total mesorectal excision for selected early rectal cancer patients. Objective Prospectively assess anorectal function and health-related quality of life of T2N0 rectal cancer patients treated with an alternative approach Design Prospective phase II trial Settings Multicentric study (ACOSOG trial Z6041) Interventions Patients with stage cT2N0 rectal adenocarcinomas were treated with an oxaliplatin/capecitabine-based chemoradiation regimen followed by local excision. Main Outcome Measure Anorectal function and quality of life were assessed at enrollment and 1 year postoperatively with the Fecal Incontinence Severity Index, Fecal Incontinence Quality of Life scale and Functional Assessment of Cancer Therapy-Colorectal questionnaire. Results were compared, and multivariable analysis was performed to identify predictors of outcome. Results Seventy-one (98%) patients were evaluated at enrollment and 66 (92%) at 1 year. Compared to baseline, no significant differences were found on Fecal Incontinence Severity Index scores at 1 year. Fecal Incontinence Quality of Life results were significantly worse in the lifestyle (p<0.001), coping/behavior (p<0.001) and embarrassment (p=0.002) domains. There were no differences in the Functional Assessment of Cancer Therapy overall score, but the physical well-being subscale was significantly worse and emotional well-being was improved after surgery. Treatment with the original chemoradiation regimen predicted worse depression/self-perception and embarrassment scores in the Fecal Incontinence Quality of Life, and male sex was predictive of worse scores in the Functional Assessment of Cancer Therapy overall score and trial outcome index. Limitations Small sample size, relatively short follow-up and absence of information before cancer diagnosis. Conclusion Chemoradiation followed by local excision had minimal impact on anorectal function 1 year after surgery. Overall quality of life remained stable, with mixed effects on different subscales. This information should be used to counsel patients about expected outcomes.

Survival analysis of local excision vs total mesorectal excision for middle and low rectal cancer in pT1/pT2 stage and intermediate pathological risk

“…Local excision (LE), including transanal excision, transanal polypectomy, and transanal endoscopic microsurgery, might be able to improve the QoL of patients by achieving similar oncological outcomes. Currently, a number of studies have and continue to focus on this issue [6, 7]. Despite its advantages, LE cannot achieve TME or provide pathological node (N) status.…”

Early and late morbidity of local excision after chemoradiotherapy for rectal cancer

“…The results, nevertheless, may be useful for decision making regarding strategies for organ preservation. Due to its low morbidity and its potential advantages in terms of quality of life 22 , LE can be considered as an alternative to watch and wait 14 , 23 . With a significantly low morbidity profile, LE can also be used as an alternative to TME in patients with incomplete responses to treatment.…”

Clinical Audit of the Radiotherapy Process in Rectal Cancer: Clinical Practice Guidelines and Quality Certification Do Not Avert Variability in Clinical Practice

“…In fact, the questionnaire does not include any items related to quality of life, which we consider to be a limitation of the study to be rectified in future audits. There is no question that awareness among professionals should be raised with regard to monitoring patients’ quality of life, and we believe that the use of a validated questionnaire in these patients could be useful for systematizing an essential dimension of clinical results [11] , [30] . Other study limitations relate to the design of the audit itself, as the sample of just 40 medical histories limits our assessment of the results and the comparison between centers, particularly for indicators on clinical results.…”