Quality of Life of Outpatients Treated with Low Anterior Resection or Anterior Resection for Colorectal Cancer

The aim of this paper is to answer the question: do we still need a permanent colostomy and present the quality of life of patients operated on for rectal cancer. A comparative analysis of patients after abdomino-perineal resection of the rectum vs. patients after low anterior resection of the rectum with preservation of sphincters is presented. When assessing the quality of life of patients, the following issues were considered: a) function of the whole organism and general condition (physical function); b) psychological well-being (psychological function); c) professional activity, relations with relatives and friends, leisure activities (social function) and d) intimate relations (sexual function). In both groups of patients, both after abdomino-perineal resection of the rectum and after low-anterior resection, a significant deterioration in the quality of life was noted. In spite of a good general health condition in the majority of cases (over 60% in both groups), frequent are irregular stools and diarrhea. Stomy patients complain about uncontrolled passing of gas and urologic problems, while patients with preserved sphincter complain about constipation. Stomy patients significantly more often suffer depression, loneliness and even despair due to low self-esteem and feeling of unfavorable change in body appearance. This feeling is present more often in younger patients and in women. Rectal cancer may cause social dysfunction, like reluctance to resume professional activity after surgery, limitation of social contacts, change of model of rest and leisure activities towards more passive forms and forms which do not require the attendance of many people. These phenomena apply to both groups but are more prominent among stomy patients. As stomy patients are usually older, some of these alterations may be due to age. Sexual dysfunction is significantly more frequent in stomy patients. Age may be one of the causes thereof. These problems are significantly more frequent in males. In some cases of colorectal cancer, the best way of management is colostomy. Further studies are needed to elaborate more clear criteria for optimal management of patients with colorectal cancer.

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Two dominant patterns of low anterior resection syndrome and their effects on patients’ quality of life

Scientific Reports ◽

10.1038/s41598-021-82149-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min Jung Kim ◽

Ji Won Park ◽

Mi Ae Lee ◽

Han-Ki Lim ◽

Yoon-Hye Kwon ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Anterior Resection ◽

Low Anterior Resection ◽

University Hospital ◽

Postoperative Treatment ◽

Low Anterior Resection Syndrome ◽

Cross Sectional ◽

Anterior Resection Syndrome

AbstractTo identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504–43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504–43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100–4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

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Quality of life after rectal cancer surgery (systematic review)

Koloproktologia ◽

10.33878/2073-7556-2021-20-1-59-67 ◽

2021 ◽

Vol 20 (1) ◽

pp. 59-67

Author(s):

A. B. Serebriy ◽

E. A. Khomyakov ◽

I. O. Nafedzov ◽

O. Yu. Fomenko ◽

E. G. Rybakov

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Life Quality ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Low Anterior Resection Syndrome

Aim: search for modifiable and unmodifiable risk factors affecting the quality of life of patients after rectal cancer surgery.Materials and methods: the literature search was done according to the keywords: quality of life, rectal cancer, low anterior resection syndrome. Twelve prospective randomized studies, 2 cohort studies, and 2 meta-analyses are included in the study. The quality of life was assessed in the analyzed studies by using questionnaires for cancer patients and updated questionnaires for colorectal cancer: EORTC QLQ-CR29, QLQ-C30, QLQ-CR38, BIQ.Results: the literary data on influence of gender, age, surgery, stoma, and chemoradiotherapy on life quality of patients after rectal cancer surgery was analyzed.Conclusion: the most significant factor affecting the life quality of patients with rectal cancer is a violation of the body image if it is necessary to form the stoma on the anterior abdominal wall. The manifestations of the low anterior resection syndrome and the urination problems are significant risk factors in the case of restoration of bowel continuity.

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Low Anterior Resection Syndrome and Quality of Life

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000116 ◽

2014 ◽

Vol 57 (5) ◽

pp. 585-591 ◽

Cited By ~ 123

Author(s):

Therese Juul ◽

Madelene Ahlberg ◽

Sebastiano Biondo ◽

Eloy Espin ◽

Luis Miguel Jimenez ◽

...

Keyword(s):

Quality Of Life ◽

Anterior Resection ◽

Low Anterior Resection ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome

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Surgical correction of functional disorders in performing sphincterosafing operations for rectal cancer (literature review)

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj20174642-654 ◽

2017 ◽

Vol 25 (4) ◽

pp. 642-654

Author(s):

E. P. Kulikov ◽

Yu. D. Kaminsky ◽

S. V. Klevcova

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Malignant Tumors ◽

Functional Results ◽

Surgical Correction ◽

Low Anterior Resection Syndrome ◽

Cumulative Function

For many decades the main goal of oncologists was to increase life expectancy of patients with malignant tumors, without paying due attention to quality of life. Currently, the goals of patients’ treatment with rectal cancer are to cure, to minimize the risk of local recurrence, preserve the normal course of intestine, to optimize it's function and to ensure quality of life. For a long time, the standard surgical treatment of patients with low rectal cancer was abdominoperineal extirpation, but recently sphincterosafing operations have seen a widespread introduction in surgical practice. However, functional results after these types of operations don't always meet the expectations of surgeons and patients. In the postoperative period, patients often develop a syndrome of low anterior resection, characterized by frequent bowel movements, repeated, prolonged and incomplete evacuation of bowel and the imperative urge to defecate. The manifestation of this syndrome can significantly impair the quality of patient's life and reduce to nothing the efforts of the surgeon to preserve the sphincter of the rectum. For surgical correction of low anterior resection syndrome, various types of colonic reservoir anastomoses have been proposed. The purpose of formation of colonic reservoirs is to increase the cumulative function of intestine. However, the existing methods have several disadvantages related to technical complications and the risk of developing evacuation dysfunction, which is the reason for search the new ways of optimization of anastomoses when performing sphincterotomy operations for cancer of the rectum.

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