Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review

Abstract

Background Low rectal cancers could be treated using restorative (anterior resection, AR) or non-restorative procedures with an end/permanent stoma (Hartmann’s, HE; or abdominoperineal excision, APE). Although the surgical choice is determined by tumour and patient factors, quality of life (QoL) will also influence the patient's future beyond cancer. This systematic review of the literature compared postoperative QoL between the restorative and non-restorative techniques using validated measurement tools. Methods The review was registered on PROSPERO (CRD42020131492). Embase and MEDLINE, along with grey literature and trials websites, were searched comprehensively for papers published since 2012. Inclusion criteria were original research in an adult population with rectal cancer that reported QoL using a validated tool, including the European Organization for Research and Treatment of Cancer QLQ-CR30, QLQ-CR29, and QLQ-CR38. Studies were included if they compared AR with APE (or HE), independent of study design. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Outcomes of interest were: QoL, pain, gastrointestinal (GI) symptoms (stool frequency, flatulence, diarrhoea and constipation), and body image. Results Nineteen studies met the inclusion criteria with a total of 6453 patients; all papers were observational and just four included preoperative evaluations. There was no identifiable difference in global QoL and pain between the two surgical techniques. Reported results regarding GI symptoms and body image documented similar findings. The ROBINS-I tool highlighted a significant risk of bias across the studies. Conclusion Currently, it is not possible to draw a firm conclusion on postoperative QoL, pain, GI symptoms, and body image following restorative or non-restorative surgery. The included studies were generally of poor quality, lacked preoperative evaluations, and showed considerable bias in the data.

Analysis of bowel function, urogenital function, and long-term follow-up outcomes associated with robotic and laparoscopic sphincter-preserving surgical approaches to total mesorectal excision in low rectal cancer: a retrospective cohort study

“…Sphincter-preserving surgical approaches to the treatment of low-rectal cancer clinical cases have been widely adopted to date, with recent studies having shown these approaches to be safe and effective [30,31], although the superiority to APR with respect to patient long-term quality of life is still controversial [32,33]. Advances in minimally invasive laparoscopic surgical techniques have Wexner Score RAS (n=169) 0 (0,0) 0 (0,1) 0 (0,1) 0 (0,0) LAS (n=404) 0 (0,0) [34,35].…”

“…In addition, experienced research nurses or doctors interviewed patients with their consent to collect the results of questionnaires pertaining to postoperative urogenital and bowel function. The First Affiliated Hospital of Anhui Medical University ethics committee accepted this investigation, with all patient participants providing informed consent (Reference number: Quick-PJ 2021- [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Quality of life meta‐analysis following coloanal anastomosis versus abdominoperineal resection for low rectal cancer

“…This is the first meta-analysis to specifically compare CAA and APR. While previous systematic reviews have addressed similar questions [31][32][33], this review included only studies defining low rectal cancer treated with coloanal anastomosis and excluding upper rectal cancer. Complete comparative data was required for meta-analysis.…”

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

“…Few studies have evaluated the comparative effectiveness of SPS with permanent stoma with respect to patient-reported outcomes (PROs). A systematic review which included nineteen studies with a total of 6453 patients concluded that it is not possible to draw a firm conclusion on postoperative QoL and body image following restorative versus non-restorative rectal cancer surgery ( 5 ).Post-treatment function and quality of life in patients with rectal cancer have been insufficiently studied ( 6 ).…”