Quality of Life and Functional Outcomes After Intersphincteric Resection for Ultralow Rectal Cancer: A Prospective Observational Study

Abstract

BACKGROUND: Intersphincteric resection is the ultimate sphincter-preserving surgical technique for ultralow rectal cancer, but quality-of-life changes after surgery remain unclear. It is also unknown which questionnaire has better associations with functional results for capturing clinical variation in quality of life.OBJECTIVE: This study aimed to assess change in the quality of life and its correlation with functional outcomes among patients undergoing intersphincteric resection for ultralow rectal cancer.

Assessing Severity of Low Anterior Resection Syndrome After Intersphincteric Resection for Ultralow Rectal Cancer: A Pilot Study Using an Exploratory Instrument

“…[2][3][4] However, in terms of functional concerns, low anterior resection syndrome (LARS) development is virtually inevitable after ISR because of a multiple surgery-and patient-related factors. [5][6][7][8][9] The LARS score and the Wexner incontinence score (WIS) are frequently adopted as patient-reported outcome measures to evaluate bowel dysfunction after rectal surgery. Although both are quick evaluation tools, the former underestimates the impact of evacuatory dysfunction, and the latter focuses only on fecal incontinence.…”

“…[10][11][12] Previous studies have demonstrated a functional recovery after ISR, but a high prevalence of LARS may persist for years. 9,13,14 It is important to note that the functional scores could not accurately mirror the real-world impact of LARS on quality of life (QoL). In clinical practice, colorectal surgeons are always confused about how some patients with major LARS can live active lives, whereas others with minor LARS have even worse QoL.…”

“…Nevertheless, this does not mean that its relevance to the patient was more significant than the fecal incontinence because of the nonvalidated nature of our exploratory instrument. Because "emptying difficulties" was an important predisposing factor for permanent stoma after ISR, 9,26 we thus speculate that it may have a possible long-term negative impact on QoL for ISR patients. This conclusion needs to be further elucidated, and a validated tool based on the Delphi consensus could provide a uniform or precise appraisal of this high-priority symptom.…”

“…24 Moreover, although the functional outcomes improved over time after ISR, a high prevalence of LARS may persist for years. 9,13,14 A distinguishing feature of the international consensus on LARS is the application of the Delphi method, which involves all important stakeholders to identify 8 symptoms and 8 consequences as the highest priorities; in addition, LARS was defined as the presence of at least one of these symptoms resulting in at least one of these consequences after rectal surgery. 16 Nevertheless, a new validated LARS tool based on the Delphi consensus has yet to be presented.…”

Rectal Cancer: New Challenges

“…Xu et al 19 found no difference in the incidence of postoperative complications in patients undergoing total neoadjuvant therapy as opposed to neoadjuvant chemoradiation for rectal cancer. Zhang et al 20 reported on the quality of life and functional outcomes following intersphincteric resection for “ultra-low” rectal cancer. They observed that low anterior resection syndrome persists for years but that functional and condition-specific outcomes improve over time.…”