Skip to main content

Advertisement

SpringerLink
Log in

Can Differences in Bowel Function After Surgery for Rectal Cancer Be Identified by the European Organization for Research and Treatment of Cancer Quality of Life Instrument?

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

ABSTRACT

Background

Bowel function is an important outcome after rectal cancer surgery that affects quality of life (QOL). Postoperative bowel function is often assessed with QOL instruments, but their ability to detect functional differences has not been evaluated. This study evaluated the efficacy of the European Organization for the Research and Treatment of Cancer (EORTC) Core (C)-30 and Colorectal (CR)-38 QOL instruments in identifying functional differences among patients undergoing sphincter-preserving surgery, grouped by clinical and treatment-related factors known to be associated with bowel function.

Methods

A total of 123 patients who underwent sphincter-preserving surgery for stage I to III rectal cancer completed the EORTC C-30 and CR-38 a median of 22.9 months after restoration of bowel continuity. The global QOL, Social and Physical Function subscales of the EORTC C-30, and Gastrointestinal (GI) Symptom and Defecation subscales of the EORTC CR-38 were hypothesized to be affected by bowel function. Known factors associated with function (age, sex, radiation, procedure, rectal reconstruction) were used to group patients. Differences in the QOL scores between patient groups were evaluated (t-test or analysis of variance).

Results

The global QOL was high, with a mean score of 76.84 ± 18.6. The Defecation subscale detected differences in patients grouped by age (P = .002), use of radiation (P = .04), and procedure type (P = .05). However, the remaining subscales failed to identify any differences.

Conclusions

We found neither the EORTC C-30 nor CR-38 to be sensitive instruments in delineating differences in bowel function. The use of a validated instrument designed to assess function in patients with rectal cancer will more effectively and efficiently identify those patients with poor postoperative function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.

Similar content being viewed by others

References

  1. Guren MG, Eriksen MT, Wiig JN, et al. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 2005; 31:735–42

    Article  PubMed  CAS  Google Scholar 

  2. Grumann MM, Noack EM, Hoffmann IA, Schlag PM. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 2001; 233:149–56

    Article  PubMed  CAS  Google Scholar 

  3. Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D. Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 2003; 238:203–13

    PubMed  Google Scholar 

  4. Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B. Prospective evaluation of quality of life of patients receiving either abdominoperineal resection or sphincter-preserving procedure for rectal cancer. Ann Surg Oncol 2005; 12:117–23

    Article  PubMed  Google Scholar 

  5. Renner K, Rosen HR, Novi G, Holbling N, Schiessel R. Quality of life after surgery for rectal cancer: do we still need a permanent colostomy? Dis Colon Rectum 1999; 42:1160–7

    Article  PubMed  CAS  Google Scholar 

  6. Sailer M, Fuchs KH, Fein M, Thiede A. Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction. Br J Surg 2002; 89:1108–17

    Article  PubMed  CAS  Google Scholar 

  7. Sideris L, Zenasni F, Vernerey D, et al. Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics. Dis Colon Rectum 2005; 48:2180–91

    Article  PubMed  Google Scholar 

  8. Moore HG, Reidel E, Minsky BD, et al. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol 2003; 10:80–5

    Article  PubMed  Google Scholar 

  9. Kuvshinoff B, Maghfoor I, Miedema B, et al. Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinomas: are < or = 1 cm distal margins sufficient? Ann Surg Oncol 2001; 8:163–9

    PubMed  CAS  Google Scholar 

  10. Rengan R, Paty P, Wong WD, et al. Distal cT2N0 rectal cancer: is there an alternative to abdominoperineal resection? J Clin Oncol 2005; 23:4905–12

    Article  PubMed  Google Scholar 

  11. Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 2005; 241:465–9

    Article  PubMed  Google Scholar 

  12. Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 2005; 48:1858–65; discussion 1865–7

    Article  PubMed  Google Scholar 

  13. Ho P, Law WL, Chan SC, Lam CK, Chu KW. Functional outcome following low anterior resection with total mesorectal excision in the elderly. Int J Colorectal Dis 2003; 18:230–3

    PubMed  Google Scholar 

  14. Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B. Impact of age on quality of life in patients with rectal cancer. World J Surg 2005; 29:190–7

    Article  PubMed  Google Scholar 

  15. Schmidt CE, Bestmann B, Kuchler T, Longo WE, Rohde V, Kremer B. Gender differences in quality of life of patients with rectal cancer. A five-year prospective study. World J Surg 2005; 29:1630–41

    Article  PubMed  Google Scholar 

  16. MacRae HM, McLeod RS. Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 1998; 41:180–9

    Article  PubMed  CAS  Google Scholar 

  17. Temple LK, Bacik J, Savatta SG, et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 2005; 48:1353–65

    Article  PubMed  Google Scholar 

  18. Montesani C, Pronio A, Santella S, et al. Rectal cancer surgery with sphincter preservation: functional results related to the level of anastomosis. Clinical and instrumental study. Hepatogastroenterology 2004; 51:718–21

    PubMed  Google Scholar 

  19. Hohn DC, Stagg RJ, Friedman MA, et al. A randomized trial of continuous intravenous versus hepatic intraarterial floxuridine in patients with colorectal cancer metastatic to the liver: the Northern California Oncology Group trial. J Clin Oncol 1989; 7:1646–54

    PubMed  CAS  Google Scholar 

  20. Hallbook O, Pahlman L, Krog M, Wexner SD, Sjodahl R. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 1996; 224:58–65

    Article  PubMed  CAS  Google Scholar 

  21. Hida J, Yoshifuji T, Tokoro T, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up. Dis Colon Rectum 2004; 47:1578–85

    Article  PubMed  Google Scholar 

  22. Dehni N, Tiret E, Singland JD, et al. Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch–anal anastomosis. Dis Colon Rectum 1998; 41:817–22; discussion 822–3

    Article  PubMed  CAS  Google Scholar 

  23. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85:365–76

    Article  PubMed  CAS  Google Scholar 

  24. Sprangers MA, te Velde A, Aaronson NK. The 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 1999; 35:238–47

    Article  PubMed  CAS  Google Scholar 

  25. Temple LK, Wong WD, Minsky B. The impact of radiation on functional outcomes in patients with rectal cancer and sphincter preservation. Semin Radiat Oncol 2003; 13:469–77

    Article  PubMed  Google Scholar 

  26. Paty PB, Enker WE, Cohen AM, Minsky BD, Friedlander-Klar H. Long-term functional results of coloanal anastomosis for rectal cancer. Am J Surg 1994; 167:90–4; discussion 94–5

    Article  PubMed  CAS  Google Scholar 

  27. Schwarz R, Hinz A. Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 2001; 37:1345–51

    Article  PubMed  CAS  Google Scholar 

  28. Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998; 16:139–44

    PubMed  CAS  Google Scholar 

  29. Kopp I, Bauhofer A, Koller M. Understanding quality of life in patients with colorectal cancer: comparison of data from a randomised controlled trial, a population based cohort study and the norm reference population. Inflamm Res 2004; 53(Suppl 2):S130–5

    PubMed  CAS  Google Scholar 

  30. Sprangers MA, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med 1999; 48:1507–15

    Article  PubMed  CAS  Google Scholar 

  31. Minsky BD, Cohen AM, Enker WE, Paty P. Sphincter preservation with preoperative radiation therapy and coloanal anastomosis. Int J Radiat Oncol Biol Phys 1995; 31:553–9

    Article  PubMed  CAS  Google Scholar 

  32. van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF. Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg 1999; 230:648–54

    Article  PubMed  Google Scholar 

  33. Hull TL, Floruta C, Piedmonte M. Preliminary results of an outcome tool used for evaluation of surgical treatment for fecal incontinence. Dis Colon Rectum 2001; 44:799–805

    Article  PubMed  CAS  Google Scholar 

  34. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36:77–97

    Article  PubMed  CAS  Google Scholar 

  35. Rockwood TH, Church JM, Fleshman JW, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 1999; 42:1525–32

    Article  PubMed  CAS  Google Scholar 

  36. Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43:9–16; discussion 16–7

    Article  PubMed  CAS  Google Scholar 

  37. O’Connor AM, Stacey D, Entwistle V, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2003:CD001431

Download references

Acknowledgments

L.K.T. is supported in this project by a Career Development Award from the American Society of Clinical Oncology and by a Limited Project Grant from the American Society of Colon and Rectal Surgeons. H.N. is a research fellow of the Agency for Healthcare Quality and Research, supported by grant 5 T32 HS000066-13.

Author information

Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York, 10021, USA

    Heather B. Neuman MD, Cynthia Cabral MD, Martin R. Weiser MD, Philip B. Paty MD, Jose G. Guillem MD, W. Douglas Wong MD & Larissa K. Temple MD, FACS

  2. Department of Biostatistics and Health Outcomes Research, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York, 10021, USA

    Deborah Schrag MD

  3. Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York, 10021, USA

    Deborah Schrag MD

  4. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York, 10021, USA

    Bruce D. Minsky MD

Authors
  1. Heather B. Neuman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah Schrag MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cynthia Cabral MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin R. Weiser MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip B. Paty MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jose G. Guillem MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bruce D. Minsky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W. Douglas Wong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Larissa K. Temple MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Larissa K. Temple MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neuman, H.B., Schrag, D., Cabral, C. et al. Can Differences in Bowel Function After Surgery for Rectal Cancer Be Identified by the European Organization for Research and Treatment of Cancer Quality of Life Instrument?. Ann Surg Oncol 14, 1727–1734 (2007). https://doi.org/10.1245/s10434-006-9283-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9283-6

Keywords

Search

Navigation