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Prospective Evaluation of Quality of Life of Patients Receiving Either Abdominoperineal Resection or Sphincter-Preserving Procedure for Rectal Cancer

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Abstract

Background

Study results on quality of life (QoL) between patients receiving an anterior resection (AR) or abdominoperineal resection (APR) for rectal cancer vary greatly. A main reason is grounded in unequal methodology. The aims of this study were to assess differences in perceived QoL over time among patients treated with AR or APR with a recommended study design and methodology.

Methods

In a prospective study, the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 and a tumor-specific module were administered to patients with rectal cancer before surgery, at discharge, and 3, 6, and 12 months after the operation. Comparisons were made between patients receiving an AR and those receiving an APR.

Results

Two hundred forty-nine patients were included; 46 patients received an APR and 203 an AR. QoL data were available for 212 patients, of which 112 were female and 100 male. No differences in the distribution of age, sex, or tumor stage were observed between groups. EORTC function scales showed no significant differences, including body image scales, between patients receiving an AR and those receiving an APR. In symptom scores, AR patients had more difficulty with diarrhea and constipation, whereas patients with APR experienced more impaired sexuality and pain in the anoperineal region. At discharge, patients receiving an AR were more confident about their future.

Conclusions

QoL in patients receiving an AR and those receiving an APR is not different. Although patients with APR experience more impaired sexuality, patients receiving an AR experience decreases in QoL because of impaired bowel function.

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References

  1. M Koller W Lorenz (1998) ArticleTitleQuality of life research in patients with rectal cancer: traditional approaches versus a problem-solving oriented perspective Langenbecks Arch Surg 383 427–36 Occurrence Handle9921942 Occurrence Handle1:STN:280:DyaK1M7hvV2itw%3D%3D

    PubMed  CAS  Google Scholar 

  2. K Renner HR Rosen G Novi et al. (1999) ArticleTitleQuality of life after surgery for colorectal cancer: do we still need a permanent colostomy? Dis Colon Rectum 42 1160–7 Occurrence Handle1:STN:280:DyaK1MvisVyktw%3D%3D Occurrence Handle10496556

    CAS  PubMed  Google Scholar 

  3. A Frigell M Ottander H Stenbeck L Pahlman (1990) ArticleTitleQuality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma Ann Chir Gynaecol 79 26–30 Occurrence Handle1:STN:280:By%2BB1M%2FitFY%3D Occurrence Handle2357050

    CAS  PubMed  Google Scholar 

  4. MA Kuzu O Topcu K Ucar et al. (2002) ArticleTitleEffect of sphincter-sacrificing surgery for rectal carcinoma on quality of life in Muslim patients Dis Colon Rectum 45 1359–66 Occurrence Handle12394435

    PubMed  Google Scholar 

  5. P Jess J Christiansen P Bech (2002) ArticleTitleQuality of life after anterior resection versus abdominoperineal extirpation for rectal cancer Scand J Gastroenterol 37 1201–4 Occurrence Handle10.1080/003655202760373425 Occurrence Handle1:STN:280:DC%2BD38nkvVyltg%3D%3D Occurrence Handle12408526

    Article  CAS  PubMed  Google Scholar 

  6. MJ Solomon CK Pager A Keshava et al. (2003) ArticleTitleWhat do patients want? Patient preferences and surrogate decision making in the treatment of colorectal cancer Dis Colon Rectum 46 1351–7 Occurrence Handle14530674

    PubMed  Google Scholar 

  7. J Engel J Kerr A Schlesinger-Raab et al. (2003) ArticleTitleQuality of life in rectal cancer patients: a four-year prospective study Ann Surg 238 203–13 Occurrence Handle10.1097/00000658-200308000-00008 Occurrence Handle12894013

    Article  PubMed  Google Scholar 

  8. ES Yeager JA Van Heerden (1980) ArticleTitleSexual dysfunction following proctocolectomy and abdominoperineal resection Ann Surg 191 169–70 Occurrence Handle7362286 Occurrence Handle1:STN:280:Bi%2BC2M3jslw%3D

    PubMed  CAS  Google Scholar 

  9. MAG Sprangers BG Taal NK Aaronson et al. (1995) ArticleTitleQuality of life in colorectal cancer: stoma vs nonstoma patients. Dis Colon Rectum 38 361–9 Occurrence Handle1:STN:280:ByqB3snos1U%3D

    CAS  Google Scholar 

  10. MM Grumann EM Noack IA Hoffmann PM Schlag (2001) ArticleTitleComparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer Ann Surg 233 149–56 Occurrence Handle10.1097/00000658-200102000-00001 Occurrence Handle1:STN:280:DC%2BD3M7ls1SnsA%3D%3D Occurrence Handle11176118

    Article  CAS  PubMed  Google Scholar 

  11. J Camilleri-Brennan RJC Steele (1998) ArticleTitleQuality of life after treatment for rectal cancer Br J Surg 85 1036–43 Occurrence Handle9717993 Occurrence Handle1:STN:280:DyaK1czot1SqsQ%3D%3D

    PubMed  CAS  Google Scholar 

  12. S Wood-Dauphinee (1999) ArticleTitleAssessing quality of life in clinical research: from where have we come and where are we going? J Clin Epidemiol 52 355–63 Occurrence Handle10235176 Occurrence Handle1:STN:280:DyaK1M3kvFamtw%3D%3D

    PubMed  CAS  Google Scholar 

  13. NK Aaronson S Ahmedzai B Bergman (1993) ArticleTitleThe European Organization for Research and Treatment of Cancer. QLQ C-30: a quality of life instrument for use in international clinical trials in oncology J Natl Cancer Inst 85 365–76 Occurrence Handle10.1093/jnci/85.5.365 Occurrence Handle1:STN:280:ByyC28vivVc%3D Occurrence Handle8433390

    Article  CAS  PubMed  Google Scholar 

  14. MA Sprangers A Cull M Groenvold et al. (1998) ArticleTitleThe European Organization for Research and Treatment of Cancer approach to developing questionnaire modules: an update and overview. EORTC Quality of Life Study Group Qual Life Res 7 291–300 Occurrence Handle1:STN:280:DyaK1c3ntlWgsQ%3D%3D Occurrence Handle9610213

    CAS  PubMed  Google Scholar 

  15. J Davidson-Homewood A Norman T Küchler et al. (2003) ArticleTitleDevelopment of a disease specific questionnaire to supplement a generic tool for QoL in colorectal cancer Psychooncology 12 675–85 Occurrence Handle14502592 Occurrence Handle1:STN:280:DC%2BD3svktF2jsw%3D%3D

    PubMed  CAS  Google Scholar 

  16. P Fayers N Aaronson K Bjordal et al. (1995) EORTC QLQ-C30 Scoring Manual EORTC Quality of Life Study Group Brussels

    Google Scholar 

  17. D Osoba G Rodrigues J Myles B Zee J Pater (1998) ArticleTitleInterpreting the significance of changes in health-related quality-of-life scores J Clin Oncol 16 139–44 Occurrence Handle1:STN:280:DyaK1c7gtFKrtw%3D%3D Occurrence Handle9440735

    CAS  PubMed  Google Scholar 

  18. B Spilker (1996) Quality of Life and Pharmacoeconomics in Clinical Trials EditionNumber2 Lippincott-Raven Philadelphia

    Google Scholar 

  19. A Thybusch C Schmidt T Küchler et al. (1999) ArticleTitleQuality of life of gastric cancer patients following gastrectomy World J Surg 23 503–8

    Google Scholar 

  20. J Engel J Kerr A Schlesinger-Raab et al. (2003) ArticleTitleComparison of breast and rectal cancer patients’ quality of life: results of a four year prospective field study Eur J Cancer Care 2 215–23

    Google Scholar 

  21. NR Maisey A Norman M Watson et al. (2002) ArticleTitleBaseline quality of life predicts survival with advanced colorectal cancer Eur J Cancer 38 1351–7 Occurrence Handle12091066 Occurrence Handle1:STN:280:DC%2BD38zkvVejsg%3D%3D

    PubMed  CAS  Google Scholar 

  22. EORTC study group on quality of life. EORTC quality of life questionnaires. October 24, 2003. Available at: http://www.eortc.be/home/qol/modules.htm. Accessed: October 30, 2003

  23. MA Sprangers A te Velde NK Aaronson et al. (1999) ArticleTitleThe construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life Eur J Cancer 35 238–47 Occurrence Handle10.1016/S0959-8049(98)00357-8 Occurrence Handle1:STN:280:DyaK1Mznslektw%3D%3D Occurrence Handle10448266

    Article  CAS  PubMed  Google Scholar 

  24. T Küchler D Henne-Bruns S Rappat et al. (1999) ArticleTitleImpact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: “survival results of a trial” Hepatogastroenterology 46 322–5 Occurrence Handle10228816

    PubMed  Google Scholar 

  25. R Schwarz A Hinz (2001) ArticleTitleReference data for the quality of life questionnaire EORTC-QLQ-C-30 in general German population Eur J Cancer 37 1345–51 Occurrence Handle11435063 Occurrence Handle1:STN:280:DC%2BD3MznvV2ruw%3D%3D

    PubMed  CAS  Google Scholar 

  26. M Pocard F Zinzindohoue F Haab S Caplin R Parc E Tiret (2002) ArticleTitleA prospective study of sexual, urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer Surgery 131 368–72 Occurrence Handle10.1067/msy.2002.122371 Occurrence Handle11935125

    Article  PubMed  Google Scholar 

  27. NK Kim TW Hahn JK Park et al. (2002) ArticleTitleAssessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer Dis Colon Rectum 45 1178–85 Occurrence Handle12352233

    PubMed  Google Scholar 

  28. AR Munday (1982) ArticleTitleAn anatomical explanation for bladder dysfunction following rectal, uterine surgery Br J Urol 52 501–4 Occurrence Handle10.1111/j.1464-410X.1982.tb13575.x

    Article  Google Scholar 

  29. HM Quah DG Jayne KW Eu F Seow-Choen (2002) ArticleTitleBladder, sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer Br J Surg 89 1551–6 Occurrence Handle12445065 Occurrence Handle1:STN:280:DC%2BD38noslajtQ%3D%3D

    PubMed  CAS  Google Scholar 

  30. I Balslev H Harling (1983) ArticleTitleSexual dysfunction following operation for carcinoma of the rectum Dis Colon Rectum 26 785–8 Occurrence Handle6685615 Occurrence Handle1:STN:280:BiuD2MjhtVM%3D

    PubMed  CAS  Google Scholar 

  31. A Nesbakken K Nygaard T Bull-Njaa E Carlsen LM Eri (2000) ArticleTitleBladder, sexual dysfunction after mesorectal excision for rectal cancer Br J Surg 87 206–10 Occurrence Handle10671929 Occurrence Handle1:STN:280:DC%2BD3c7jslynug%3D%3D

    PubMed  CAS  Google Scholar 

  32. CY Ko LC Rusin DJ Schoetz et al. (2002) ArticleTitleUsing quality of life scores to help determine treatment: is restoring bowel continuity better than an ostomy? Colorectal Dis 4 41–7 Occurrence Handle12780654

    PubMed  Google Scholar 

  33. L Kohler R Menningen E Eypasch H Troidl (1991) ArticleTitleUlcerative colitis: quality of life after surgery Dtsch Med Wochenschr 116 1362–7 Occurrence Handle10.1055/s-2008-1063759 Occurrence Handle1884676 Occurrence Handle1:STN:280:By6A2MnpslQ%3D

    Article  PubMed  CAS  Google Scholar 

  34. J Camilleri-Brennan A Munro RJ Steele (2003) ArticleTitleDoes an ileoanal pouch offer better quality of life than a permanent ileostomy for patients with ulcerative colitis? J Gastrointest Surg 7 814–9 Occurrence Handle10.1016/S1091-255X(03)00103-3 Occurrence Handle13129563

    Article  PubMed  Google Scholar 

  35. SA Seidel M Newman KW Sharp (2000) ArticleTitleIleoanal pouch versus ileostomy: is there a difference in quality of life? Am Surg 66 540–6 Occurrence Handle10888129 Occurrence Handle1:STN:280:DC%2BD3M%2Fhs1aitQ%3D%3D

    PubMed  CAS  Google Scholar 

  36. C Huguet J Harb S Bona (1990) ArticleTitleColoanal anastomosis after resection of low rectal cancer in the elderly World J Surg 14 619–22 Occurrence Handle1:STN:280:By6D2cbntVw%3D Occurrence Handle2238662

    CAS  PubMed  Google Scholar 

  37. DP O’Leary CJ Fide C Foy ME Lucarotti (2001) ArticleTitleQuality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma Br J Surg 88 1216–20 Occurrence Handle10.1046/j.0007-1323.2001.01862.x Occurrence Handle1:STN:280:DC%2BD3MvovF2jtg%3D%3D Occurrence Handle11531870

    Article  CAS  PubMed  Google Scholar 

  38. J Camilleri-Brennan RJC Steele (2001) ArticleTitleProspective analysis of quality of life and survival following mesorectal excision for rectal cancer Br J Surg 88 1617–22 Occurrence Handle10.1046/j.0007-1323.2001.01933.x Occurrence Handle1:STN:280:DC%2BD3MnptVGmtg%3D%3D Occurrence Handle11736975

    Article  CAS  PubMed  Google Scholar 

  39. J Comb (2003) ArticleTitleRole of the stoma care nurse: patients with cancer and colostomy Br J Nurs 12 852–6 Occurrence Handle12951536

    PubMed  Google Scholar 

  40. NS Williams D Johnston (1983) ArticleTitleThe quality of life after rectal excision for low rectal cancer Br J Surg 70 460–2 Occurrence Handle1:STN:280:BiyB2Mfis1A%3D Occurrence Handle6871635

    CAS  PubMed  Google Scholar 

  41. LA Festinger (1957) A Theory of Cognitive Dissonance Stanford University Press Palo Alto, CA

    Google Scholar 

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Authors and Affiliations

  1. Department of General and Thoracic Surgery, University of Kiel, Arnold-Heller-Str. 7, 24105, Kiel, Germany

    Christian E. Schmidt MD, MPH & Bernd Kremer MD, PhD

  2. Reference Center for Quality of Life, University of Kiel, Arnold-Heller-Str. 5, 24105, Kiel, Germany

    Beate Bestmann MA & Thomas Küchler PhD

  3. Department of Surgery, Section of Gastrointestinal Surgery, Yale UniversitySchool of Medicine, New Haven, P.O. Box 208062, Connecticut, 06520-8062

    Walter E. Longo MD, MBA

Authors
  1. Christian E. Schmidt MD, MPH
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  2. Beate Bestmann MA
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  3. Thomas Küchler PhD
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  4. Walter E. Longo MD, MBA
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  5. Bernd Kremer MD, PhD
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Corresponding author

Correspondence to Christian E. Schmidt MD, MPH.

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Schmidt, C., Bestmann, B., Küchler, T. et al. Prospective Evaluation of Quality of Life of Patients Receiving Either Abdominoperineal Resection or Sphincter-Preserving Procedure for Rectal Cancer. Ann Surg Oncol 12, 117–123 (2005). https://doi.org/10.1245/ASO.2005.12.036

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  • DOI: https://doi.org/10.1245/ASO.2005.12.036

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