Quality of life and function after rectal cancer surgery with and without sphincter preservation

Abstract

Despite improvements in surgical techniques, functional outcomes and quality of life after therapy for rectal cancer remain suboptimal. We sought to prospectively evaluate the effect of bowel, bladder, and sexual functional outcomes on health-related quality of life (QOL) in patients with restorative versus non-restorative resections after rectal cancer surgery. A cohort of 211 patients with clinical stage I-III rectal cancer who underwent open surgery between 2006 and 2009 at Memorial Sloan Kettering were included. Subjects were asked to complete surveys preoperatively and at 6, 12, and 24 months after surgery. Validated instruments were used to measure QOL, bowel, bladder, and sexual function. Univariable and multivariable regression analyses evaluated predictors of 24- month QOL. In addition, longitudinal trends over the study period were evaluated using repeated measures models. In total, 180 patients (85%) completed at least 1 survey, and response rates at each time point were high (>70%). QOL was most impaired at 6 and 12 months and returned to baseline levels at 24 months. Among patients who underwent sphincter-preserving surgery (SPS; n=153 [85%]), overall bowel function at 24 months was significantly impaired and never returned to baseline. There were no differences in QOL at 24 months between patients who underwent SPS and those who did not (p=.29). Bowel function was correlated with QOL at 24 months (Pearson correlation,.41; p<.001). QOL among patients who have undergone SPS for rectal cancer is good despite poor function. Patients with ostomies are able to adjust to the functional changes and, overall, have good global QOL. Patients with low anastomoses had lower global QOL at 24 months than patients with permanent stomas. Our findings can help patients set expectations about function and quality of life after surgery for rectal cancer with and without a permanent stoma.

Shame in patients undergoing ureterostomy: A cross‐sectional survey

“…Multiple angles tarted on those influencing factors are needed to interfere with the sense of shame of patients with ureterostomy. From the government level, a larger range and higher proportion of health insurance coverage for these diseases can reduce the financial burden of low‐income patients and ensure their quality of life 32,33 . From the hospital level, provide a platform for communication, such as holding more colostomy fraternity meetings, using chat tools such as Wechat software to provide information support for patients, encourage patients to exchange nursing experiences and provide peer support 34–36 .…”

Effect of a Mobile Health–Based Remote Interaction Management Intervention on the Quality of Life and Self-Management Behavior of Patients With Low Anterior Resection Syndrome: Randomized Controlled Trial

“…This operation preserves anal function and avoids the inconvenience and pressure caused by permanent colostomy [4] . However, 70%-90% of patients after SPS struggle with long-term anorectal functional disturbances called low anterior resection syndrome (LARS) [5,6] .…”

Quality of life of patients with permanent colostomy and low anterior resections (meta-analysis)

“…До 90% этих больных сталкивается с синдромом низкой передней резекции, который характеризуется частыми и неотложными позывами к дефекации, затрудненным и неполным опорожнением кишечника и проблемами, связанными с контролем стула [6]. Помимо этого, пациенты, оперированные по поводу рака прямой кишки, встречаются и с другими неприятными симптомами: болью в области таза, нарушением кишечной функции, привязанностью к туалету, сексуальной и мочевой дисфункцией [7]. Кроме того, каждый четвертый больной раком прямой кишки сталкивается c необходимостью формирования постоянной стомы на передней брюшной стенке, что негативным образом отражается на качестве жизни [8].…”

“…Согласно полученным данным, значимых различий в глобальном качестве жизни между группами пациентов, перенесших брюшно-промежностную экстирпацию и переднюю резекцию прямой кишки, выявлено не было (p > 0,05) [10]. Более того, некоторые работы указывают на то, что в отдаленной перспективе пациенты с низкими колоректальными анастомозами имели худшее качество жизни [7]. Учитывая противоречивый характер описанных проблем, с целью актуализации литературных данных, нами был проведен метаанализ, объединивший результаты лечения 2244 пациентов из 9 ретроспективных исследований, которым была выполнена операция с формированием постоянной стомы на передней брюшной стенке или сфинктеросохраняющее лечение.…”