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Kuzmanovska B, Kuzmanovski I, Jankulovski N, Kartalov A, Osmani B, Srceva M, Brzanov N, Gavrilovska -Brzanov A. Patient-reported health-related quality of life after colorectal surgery. POLISH JOURNAL OF SURGERY 2021; 94:20-26. [DOI: 10.5604/01.3001.0015.5540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Colorectal cancer is one of the most common cancers worldwide. In most of these patients, quality of life is deteriorated. </br></br> <b>Aim:</b> The aim of our study was to analyze how the disease affects health-related quality of life (HRQoL) and to examine the role of demographic, disease-related, and other factors in the overall quality of life. The second aim was to identify areas where HRQoL could be improved. </br></br> <b> Material and methods:</b> A cross-sectional questionnaire survey was conducted. The study included a modified version of EQ-5D, as well as clinical and socioeconomic characteristics of the country. Patients over the age of 18, who had colorectar surgery, and were followed up at our clinic, were included in the survey. </br></br> <b>Results:</b> In patients after colorectal surgery, bowel control is a major concern that has an impact on their quality of life. The majority of patients expressed gratitude for the care they received and thanked the health-care providers for it. With the EQ-5D modified questionnaire, the concept of "perfect" health was reviewed and analyzed. A response "no difficulty" in any of the five domains was classified as perfect health. Only one-third of the patients said their health was “ideal” (no problems in any of the EQ-5D five domains). </br></br> <b>Discussion:</b> According to the results of this study, patients with CRC have considerably poorer HRQoL than the general population, as indicated by the EQ-5D utility scores. This discovery is in line with some previous research. </br></br> <b>Conclusion:</b> Colorectal surgery survivors' total HRQoL has been found to be lower than in the general population.
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Affiliation(s)
- Biljana Kuzmanovska
- University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
| | - Igor Kuzmanovski
- University Clinic for Neurology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
| | - Nikola Jankulovski
- University Clinic for Abdominal Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
| | - Andrijan Kartalov
- University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
| | - Bujar Osmani
- University Clinic for Abdominal Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
| | - Marija Srceva
- University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
| | - Nikola Brzanov
- University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
| | - Aleksandra Gavrilovska -Brzanov
- University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R. Macedonia
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Transperineal minimally invasive abdominoperineal resection for low rectal cancer: standardized technique and clinical outcomes. Surg Endosc 2021; 35:7236-7245. [PMID: 34254186 DOI: 10.1007/s00464-021-08633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite the increasing utilization of transanal total mesorectal excision as a promising approach for low rectal cancer, the feasibility and safety of transperineal minimally invasive abdominoperineal resection (tp-APR) remain unclear. METHODS In total, 25 patients who underwent tp-APR between April 2017 and May 2020 (tp-APR group) and 27 patients who underwent conventional laparoscopic APR between May 2009 and September 2016 (lap-APR group) for low rectal cancer were enrolled in this retrospective study. Clinical outcomes were compared between the groups before and after propensity score matching. The primary outcome was the incidence of the overall postoperative complications with Clavien-Dindo grade II or above. Standardized technique of tp-APR was also demonstrated. RESULTS On comparison, operative time, intraoperative blood loss, and overall postoperative complications with Clavien-Dindo grade II or above were significantly less in the tp-APR group both before and after propensity score matching. The rates of urinary disturbance and perineal wound infection were significantly less in the tp-APR group after matching. Further, postoperative hospital stay was significantly shorter in the tp-APR group both before and after matching. However, pathological outcomes did not differ between the groups before and after matching. There has been no local recurrence in the tp-APR group with a median follow-up period of 18 months. CONCLUSION Standardized tp-APR for low rectal cancer is feasible and seems superior to conventional laparoscopic APR in terms of short-term outcomes. Further larger-scale studies with a longer follow-up period are required to evaluate oncological outcomes.
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Perry WRG, Abd El Aziz MA, Duchalais E, Grass F, Behm KT, Mathis KL, Kelley SR. Sexual dysfunction following surgery for rectal cancer: a single-institution experience. Updates Surg 2021; 73:2155-2159. [PMID: 34236596 DOI: 10.1007/s13304-021-01124-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
Although much focus is placed on oncological outcomes for rectal cancer, it is important to assess quality of life after surgery of which sexual function is an important component. This study set about to describe the prevalence of sexual dysfunction by resection type and gender among patients undergoing surgery for rectal cancer, usingretrospective analysis. All English-speaking living patients who underwent surgery for stage I-III rectal cancer with curative intent between 2012 and 2016 were identified from a prospectively maintained database at our institution. Eligible patients were invited to complete either the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF). Primary outcomes were overall rates of sexual dysfunction, defined as more than one standard deviation below the mean of the normal population for each tool. A total of 147 patients responded, yielding a response rate of 38%. The overall sexual dysfunction rate was 70% at a median time from surgery of 38 months. Sixty-two men (62%) and 41 women (87%) reported overall scores that fell below one standard deviation of the population mean. There was no significant difference in sexual dysfunction for both male and female patients between low anterior resection, coloanal anastomosis, or abdominoperineal resection.. The present study revealed a high rate of sexual dysfunction after rectal cancer surgery, particularly in female patients. This study serves as a reminder to surgeons and their teams to openly discuss the impact of surgery on sexual function and ensure adequate consent and appropriate peri-operative management strategies. The retrospective nature of the analysis is the limitation of this study.
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Affiliation(s)
- William R G Perry
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA
| | - Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA.,Internal Medicine Department, Texas Tech University HSC El Paso/The Hospitals of Providence Transmountain Campus, 2000B Transmountain Road, Suite 400
- MSC 42001, El Paso, TX, 79911, USA
| | - Emilie Duchalais
- Digestive and Endocrine Surgery Clinic (CCDE), Institute of Diseases of the Digestive System (IMAD), University Hospital Center of Nantes, 1, Place Alexis-Ricordeau, 44093, Nantes, France
| | - Fabian Grass
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA.,Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, RochesterRochester, MN, 55905, USA.
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Robotic versus transanal total mesorectal excision in sexual, anorectal, and urinary function: a multicenter, prospective, observational study. Int J Colorectal Dis 2021; 36:2749-2761. [PMID: 34537862 PMCID: PMC8589758 DOI: 10.1007/s00384-021-04030-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Improved long-term survival after low anterior resection (LAR) for rectal cancer highlights the importance of functional outcome. Urogenital and anorectal dysfunction is frequently reported after conventional LAR. Advanced minimally invasive techniques such as robotic (RoTME) and transanal total mesorectal excision (TaTME) might improve functional results by precisely dissecting and preserving autonomic nerves. We compared functional outcomes after RoTME or TaTME in a multicenter study. METHODS One hundred twenty patients (55 RoTME/65 TaTME) were prospectively included in four participating centers. Anorectal (Wexner and low anterior resection syndrome (LARS) Score), urinary (International Consultation on Incontinence-Male/Female Lower Urinary Tract Symptoms Score (ICIQ-MLUTS/ICIQ-FLUTS) and International Prostate Symptom Scale (IPSS)), and sexual (International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI)) outcomes at 12 months after surgery were compared to preoperative scores. The response rate to the 1-year postoperative functional assessment by questionnaire was 79.5%. RESULTS RoTME enabled better anorectal function compared to TaTME (LARS score 4.3 ± 2.2 vs. 9.8 ± 1.5, p = 0.038, respectively). TaTME proved superior at preserving male urinary function, while female urinary function was comparable in both groups, with only mild postoperative impairment (RoTME vs. TaTME, respectively: ICIQ-MLUTS 13.8 ± 4.9 vs. 1.8 ± 5.8, p = 0.038; ICIQ-FLUTS Incontinence Score - 0.3 ± 1.0 vs. - 0.2 ± 0.9, p = 0.844). Both techniques demonstrated comparable male (RoTME - 13.4 ± 2.7 vs. TaTME - 11.7 ± 3.4, p = 0.615) and female (RoTME 5.2 ± 4.6 vs. TaTME 10.5 ± 6.4, p = 0.254) sexual function. CONCLUSION After adjustment for risk factors, RoTME provided better anorectal functional results, whereas TaTME was better at preserving male urinary function. Overall, both techniques demonstrated only mild postoperative functional impairment.
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Quality of life and patient satisfaction after single- and multiport laparoscopic surgery in colon cancer: a multicentre randomised controlled trial (SIMPLE Trial). Surg Endosc 2020; 35:6278-6290. [PMID: 33141277 DOI: 10.1007/s00464-020-08128-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The clinical benefits of single-port laparoscopic surgery (SPLS) in patients with colon cancer patients are unclear because only a few studies have reported on the quality of life (QoL) of such patients. This study aimed to compare the QoL and patient satisfaction between SPLS and multiport laparoscopic surgery (MPLS) in colon cancer. METHODS The multicentre randomised controlled SIngle-port versus MultiPort Laparoscopic surgEry (SIMPLE) trial included patients with colon cancer who underwent radical surgery at seven hospitals in South Korea. We performed a pre-planned secondary analysis of the QoL data of 359 patients from that trial. The QoL was surveyed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 preoperatively and at 1, 3, 6, and 12 months postoperatively. Patient satisfaction was measured with a 5-point questionnaire at these postoperative time points. RESULTS Overall, 145 and 147 patients were included in the SPLS and MPLS groups, respectively. Most QoL domains were similar between the groups. In the subgroup analysis of patients without adjuvant chemotherapy, patients in the SPLS group presented with significantly better global health status (p = 0.017), fatigue (p = 0.047), and pain (p = 0.005) scores and tended to have improved physical (p = 0.055), emotional (p = 0.064), and social (p = 0.081) functioning, with marginal significance at 1 month postoperatively, compared to those in the MPLS group. Patient satisfaction regarding surgery (p = 0.002) and appearance of the abdominal scar (p = 0.002) was significantly higher with SPLS than with MPLS at 12 months postoperatively. CONCLUSION Patients who underwent SPLS without adjuvant chemotherapy had better global health status, fatigue status, and pain at 1 month postoperatively; however, these improvements were minimal and temporary. In the near future, the effect of SPLS on postoperative QoL should be confirmed through a randomised controlled trial targeting the QoL in colon cancer patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01480128.
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Artus A, Tabchouri N, Iskander O, Michot N, Muller O, Giger-Pabst U, Bourlier P, Bourbao-Tournois C, Kraemer-Bucur A, Lecomte T, Salamé E, Ouaissi M. Long term outcome of anastomotic leakage in patients undergoing low anterior resection for rectal cancer. BMC Cancer 2020; 20:780. [PMID: 32819329 PMCID: PMC7439541 DOI: 10.1186/s12885-020-07109-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background The influence of anastomotic leakage (AL) on local recurrence rates and survival in rectal cancer remains controversial. The aim of this study was to analyze the effect of asymptomatic anastomotic leakage (AAL) and symptomatic anastomotic leakage (SAL) on short- and long-term outcome after curative rectal cancer resection. Methods All patients who underwent surgical resection of non-metastatic rectal cancer with curative intent from January 2005 to December 2017 were retrospectively analyzed. Short-term morbidity, long-term functional and oncological outcomes were compared between patients with SAL, AAL and without AL (WAL). Results Overall, 200 patients were included and AL was observed in 39 (19.5%) patients (10 AAL and 29 SAL) with a median follow-up of 38.5 months. Rectal cancer location and preoperative neoadjuvant treatment was similar between the three groups. Postoperative 30-day mortality rate was nil. The permanent stoma rate was higher in patients with SAL or AAL compared to WAL patients (44.8 and 30% vs 9.3%, p < 0.001). The mean wexner continence grading scale was significantly different between AAL (11,4 ± 3,8), SAL (10,3 ± 0,6) and WAL (6,4 ± 4,7) groups (p = 0.049). The 3 and 5-year overall and disease-free survival rates were similar between the 3 groups (86.6% /84% vs 100%/100% vs 76%/70 and 82.9%/77% vs 100%/100% vs 94.7%/88.3% for patients with SAL, AAL, and WAL, p = 0.480 and p = 0.527). Conclusion The permanent stoma rate was significant higher in patients with SAL or AAL compared to WAL patients. AL did not impair long-term oncological outcome.
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Affiliation(s)
- Alice Artus
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Nicolas Tabchouri
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Othman Iskander
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Nicolas Michot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Olivier Muller
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Urs Giger-Pabst
- Department of General-, Visceral- and Transplant Surgery, University of Münster, Münster, Germany
| | - Pascal Bourlier
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Céline Bourbao-Tournois
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Aurore Kraemer-Bucur
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Tours, France
| | - Ephrem Salamé
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France.
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Suzuki T, Sadahiro S, Tanaka A, Okada K, Saito G, Miyakita H, Akiba T, Yamamuro H. Outcomes of Local Excision plus Chemoradiotherapy in Patients with T1 Rectal Cancer. Oncology 2018; 95:246-250. [PMID: 29909419 DOI: 10.1159/000489930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/08/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The National Comprehensive Cancer Network (NCCN) guidelines recommend local excision and observation as standard treatment for selected patients with clinical T1N0M0 rectal cancer. In patients with pathological T1 (pT1) rectal cancer who received local excision, the local recurrence rate is at least 10%. We studied oncological outcomes in patients with pT1 rectal cancer who received chemoradiotherapy (CRT) after local excision. METHODS Local excision was performed in 65 patients with clinical T1N0M0 rectal cancer (≤8 cm from the anal verge, tumor size < 30 mm, well or moderately differentiated adenocarcinoma). The patients received CRT (40 or 45 Gy in 1.8-2.0 fractions with concurrent oral UFT [tegafur/uracil] or S-1 [tegafur/gimeracil/ote-racil]) after confirmation of pT1 and negative margins. RESULTS Patients who had pT2 cancer or who did not provide informed consent were excluded. The remaining 50 patients additionally received CRT. The CRT was completed in 48 patients (96%). The median follow-up period was 71 months. Local recurrence occurred in 1 patient (2%). Distant metastases occurred in 3 patients (6%). The 5-year disease-free survival rate was 86%, and the 5-year overall survival rate was 92%. CONCLUSIONS Our study suggested that multidisciplinary treatment with local excision plus CRT can be used as a treatment option in selected patients with clinical T1N0M0 rectal cancer.
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Affiliation(s)
- Toshiyuki Suzuki
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Akira Tanaka
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Kazutake Okada
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Gota Saito
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroshi Miyakita
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Takeshi Akiba
- Department of Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroshi Yamamuro
- Department of Radiology, Tokai University School of Medicine, Kanagawa, Japan
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Thomaschewski M, Neeff H, Keck T, Neumann HPH, Strate T, von Dobschuetz E. Is there any role for minimally invasive surgery in NET? Rev Endocr Metab Disord 2017; 18:443-457. [PMID: 29127554 DOI: 10.1007/s11154-017-9436-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuroendocrine tumors (NET) represent the variability of almost benign lesions either secreting hormones occurring as a single lesion up to malignant lesions with metastatic potential. Treatment of NET is usually performed by surgical resection. Due to the rarity of NET, surgical treatment is mainly based on the experience and recommendations of experts and less on the basis of prospective randomized studies. In addition, the development and establishment of new surgical procedures is made more difficult by their rarity. The development of laparoscopic-assisted surgery has significantly improved the treatment of many diseases. Due to the well-known advantages of laparoscopic surgery, this method has also been increasingly used to treat NET. However, due to limited comparative data, the assumed superiority of laparoscopic surgery in the area NET remains often unclear or not yet proven. This review focuses on the present usage of laparoscopic techniques in the area of NET. Relating to the current literature, this review presents the evidence of various laparoscopic procedures for treatment of adrenal, pancreatic and intestine NET as well as extraadrenal pheochromocytoma and neuroendocrine liver metastases. Further, this review focuses on recent new developments of minimally invasive surgery in the area of NET. Here, robotic-assisted surgery and single-port surgery are promising approaches.
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Affiliation(s)
- M Thomaschewski
- Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - H Neeff
- Department of Visceral and General Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - T Keck
- Department of Surgery, University of Lübeck and University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - H P H Neumann
- Section for Preventive Medicine, Department of Nephrology and General Medicine, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
| | - T Strate
- Department of General, Visceral and Thoracic Surgery, Academic Teaching Hospital University of Hamburg, Reinbek, Germany
| | - E von Dobschuetz
- Section of Endocrine Surgery, Department of General, Visceral and Thoracic Surgery, Academic Teaching Hospital University of Hamburg, Reinbek, Germany.
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Quality of Life in Rectal Cancer Patients After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection - A Matched-Controlled Study. Dis Colon Rectum 2017; 60:1032-1040. [PMID: 28891846 DOI: 10.1097/dcr.0000000000000862] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome. OBJECTIVE The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group). DESIGN This was a matched controlled study. SETTINGS This study was conducted at multiple centers. PATIENTS The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery. Patients were matched on sex, age, tumor stage, and tumor height. All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years. MAIN OUTCOME MEASURES Quality of life was measured by validated questionnaires covering general quality of life (Short Form 36, European Organization for Research and Treatment of Cancer QLQ-C30), disease-specific total mesorectal excision (European Organization for Research and Treatment of Cancer QLQ-CR38), defecation problems (Vaizey and low anterior resection syndrome scores), sexual problems (International Index of Erectile Function and Female Sexual Function Index), and urinary dysfunction (International Prostate Symptom Score). RESULTS The watch-and-wait group showed better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function. LIMITATIONS This study only focused on watch-and-wait patients who achieved a sustained complete response for 2 years. In addition, this is a study with a limited number of patients and with quality-of-life measurements on nonpredefined and variable intervals after surgery. CONCLUSIONS After a successful watch-and-wait approach, the quality of life was better than after chemoradiation and surgery on several domains. However, chemoradiation therapy on its own is not without long-term side effects, because one-third of the watch-and-wait patients experienced major low anterior resection syndrome symptoms, compared with 66.7% of the patients in the total mesorectal excision group. See Video Abstract at http://links.lww.com/DCR/A395.
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Cabilan CJ, Hines S. The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:517-566. [PMID: 28178025 DOI: 10.11124/jbisrir-2016003282] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients. OBJECTIVES To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis. INCLUSION CRITERIA TYPES OF PARTICIPANTS Colorectal cancer survivors aged 18 years and over. TYPES OF INTERVENTIONS Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy. TYPES OF STUDIES Pre- and post-observational and experimental studies. OUTCOMES Physical activity, ability to perform activities of daily living (functional status) and QoL. SEARCH STRATEGY CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015. METHODOLOGICAL QUALITY All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA EXTRACTION Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software. DATA SYNTHESIS The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form. RESULTS A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies. CONCLUSION In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment. IMPLICATIONS FOR PRACTICE The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors. IMPLICATIONS FOR RESEARCH The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.
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Affiliation(s)
- C J Cabilan
- 1Nursing Research Centre, Mater Misericordiae Limited, and The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence 2School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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Simillis C, Hompes R, Penna M, Rasheed S, Tekkis PP. A systematic review of transanal total mesorectal excision: is this the future of rectal cancer surgery? Colorectal Dis 2016; 18:19-36. [PMID: 26466751 DOI: 10.1111/codi.13151] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/21/2015] [Indexed: 12/17/2022]
Abstract
AIM The surgical technique used for transanal total mesorectal excision (TaTME) was reviewed including the oncological quality of resection and the peri-operative outcome. METHOD A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify studies reporting on TaTME. RESULTS Thirty-six studies (eight case reports, 24 case series and four comparative studies) were identified, reporting 510 patients who underwent TaTME. The mean age ranged from 43 to 80 years and the mean body mass index from 21.7 to 31.8 kg/m(2) . The mean distance of the tumour from the anal verge ranged from 4 to 9.7 cm. The mean operation time ranged from 143 to 450 min and mean operative blood loss from 22 to 225 ml. The ratio of hand-sewn coloanal to stapled anastomoses performed was 2:1. One death was reported and the peri-operative morbidity rate was 35%. The anastomotic leakage rate was 6.1% and the reoperation rate was 3.7%. The mean hospital stay ranged from 4.3 to 16.6 days. The mesorectal excision was described as complete in 88% cases, nearly complete in 6% and incomplete in 6%. The circumferential resection margin was negative in 95% of cases and the distal resection margin was negative in 99.7%. CONCLUSION TaTME is a feasible and reproducible technique, with good quality of oncological resection. Standardization of the technique is required with formal training. Clear indications for this procedure need to be defined and its safety further assessed in future trials.
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Affiliation(s)
- C Simillis
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - R Hompes
- Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK
| | - M Penna
- Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK
| | - S Rasheed
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - P P Tekkis
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
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Short-term results of quality of life for curatively treated colorectal cancer patients in Lithuania. MEDICINA-LITHUANIA 2015; 51:32-7. [PMID: 25744773 DOI: 10.1016/j.medici.2015.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 01/18/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Treatment options for colorectal cancer patients create the need to assess the quality of life (QoL) of colorectal cancer patients in the early postoperative period when changes are potentially greatest. The aim of the current study was to assess the QoL of colorectal cancer patients following open and laparoscopic colorectal surgery. MATERIALS AND METHODS A total of 82 consecutive patients requiring elective open or laparoscopic colorectal surgery were recruited to the study for 3 months in the three colorectal surgery centers of Lithuania. Patients completed the EORTC QLQ-C30 (version 3.0) questionnaire before surgery, 2 and 5 days, 1 and 3 months after operation. The EORTC QLQ-CR29 questionnaire was completed before surgery and at 1 and 3 months after operation. Analysis was done according to the manual for each instrument. RESULTS EORTC QLQ-C30 reflected the postoperative recovery of QoL. The global health status, cognitive and emotional functioning came back to the preoperative level in one month after operation. Physical and role functioning for laparoscopic group was significantly improved in 1 month after operation and in 3 months for open surgery group respectively. Colorectal module EORTC-QLQ-CR29 found that future perspective increased significantly in laparoscopic group 1 month after operation. CONCLUSIONS The present study showed that majority of functional scale scores came back to the preoperative level during the first 3 months after colorectal cancer surgery. Differences in QoL according to surgical approach are mostly expressed on this period.
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Shamiyeh A, Gabriel M. Laparoscopic resection of gastrointestinal neuroendocrine tumors with special contribution of radionuclide imaging. World J Gastroenterol 2014; 20:15608-15. [PMID: 25400444 PMCID: PMC4229525 DOI: 10.3748/wjg.v20.i42.15608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/22/2014] [Accepted: 05/23/2014] [Indexed: 02/06/2023] Open
Abstract
The surgical treatment of neuroendocrine tumors (NETs) draws on experience and guidelines more than on prospective randomized trials. The incidence of NET is increasing in all parts of the gastrointestinal tract. A variety of classifications introduced over the last decade may have led to difficulties in judging clinical relevance and determining the right surgical strategy. The North American Neuroendocrine Tumor Society and the European Neuroendocrine Tumor Society have developed usable guidelines from the available literature. For more than 20 years laparoscopy has developed as the gold standard for various surgical indications. Nevertheless, few trials have compared open and laparoscopic surgery with regard to NET. This review summarizes the recent literature on surgery for NET and incorporates the evidence on laparoscopy for cancer which might be also applied for NET.
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A prospective video-controlled study of genito-urinary disorders in 35 consecutive laparoscopic TMEs for rectal cancer. Surg Endosc 2014; 29:1721-8. [PMID: 25303909 DOI: 10.1007/s00464-014-3876-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/20/2014] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Genito-urinary disorders (GUD) for radical rectal cancer surgery range from 10 to 30%. In this study, primary endpoint is to prospectively assess their incidence in patients undergoing Laparoscopic Total Mesorectal Excision (LTME) without neoadjuvant chemo-radiation (NCR). Secondary endpoint is to detect the potential lesion site evaluating video-recordings of surgery. PATIENTS AND METHODS A study of 35 consecutive patients treated by LTME for extra-peritoneal rectal cancer not subjected to NCR, M:F = 23:12, median age 70, was evaluated preoperatively by Uroflowmetry and US postvoid residual urine measurement (PVR), International Prostatic Symptoms Score (IPSS), and International Consultation on Incontinence Modular Questionnaire (ICIQ) at 1 and 9 months post-operatively. Evaluation of sexual function was carried out by International Index of Erectile Function (IIEF) in males. Data were analyzed performing Fisher and paired samples t tests. Surgical videos of patients affected by GUD were reviewed to identify lesion sites. RESULTS Urinary function:IPSS average score: baseline 6.03 ± 5.51, 8.93 ± 6.42 (p = .005) at 1 month, and 7.26 ± 5.55 (p = .041) at 9 months. ICIQ baseline 2.67 ± 5.42, 4.27 ± 6.19 (p = NS) at 1 month, and 3.63 ± 5.23 (p = NS) at 9 months. Maximum urine flow rate baseline 15.95 ± 4.78 ml/s, 14.23 ± 5.27 after 1 month (p = .041), and 15.22 ± 4.01 after 9 months (p = NS). Mean urine flow rate baseline 9.15 ± 2.96 ml/s, 7.99 ± 4.12 ml/s at 1 month (p = .044), and 8.54 ± 4.19 ml/s at 9 months (p = NS). PVR baseline 59.62 ± 54.49, 64.59 ± 58.71 (p = NS) at 1 month, and 68.82 ± 77.72 (p = NS) at 9 months. Sexual function: IIEF baseline 19.38 ± 6.25, 14.06 ± 8.65 at 1 month (p = .011), and 15.4 ± 8.41 at 9 months, (p = NS). Video review of patients with disorders showed potential damage at the site of ligation of IMA (high hypogastric plexus) in 1 case, lateral and posterior mesorectum dissection (hypogastric nerves) in 2 cases, anterior dissection of the Denonvilliers fascia from seminal vesicles in 2 cases. CONCLUSIONS GUD at 1 month from LTME for rectal cancer are significant but improve at 9 months. Surgical video review of patients with GUD provides an important tool for detection of lesion sites.
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Sales PMG, Carvalho AF, McIntyre RS, Pavlidis N, Hyphantis TN. Psychosocial predictors of health outcomes in colorectal cancer: a comprehensive review. Cancer Treat Rev 2014; 40:800-9. [PMID: 24679516 DOI: 10.1016/j.ctrv.2014.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/28/2014] [Accepted: 03/03/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND A diagnosis of colorectal cancer (CRC) and its long-term treatment may lead to significant psychological distress and impaired health-related quality of life (HRQoL) for a significant proportion of patients. METHODS We searched the PubMed/MEDLINE electronic database for available literature on the associations between personality characteristics, depression, psychological distress and HRQoL in CRC. Additional references were identified through the citation tracking of the included articles. RESULTS Recent evidence indicates that Type-D (distressed) personality may predict distress among CRC patients. Additionally, other personality traits, such as specific ego defense mechanisms, influence the coping responses and HRQoL. Although the presence of a stoma has been linked to the development of depressive symptoms and impairment in HRQoL in CRC patients, more prospective studies are necessary to confirm these associations. Sense of coherence (SOC) has both a moderating and mediating effect on health (especially mental health and HRQoL), and preliminary data indicate that SOC may be an independent predictor of CRC survival. CONCLUSIONS The interplay between personality variables during the elaboration of "the impaired role" is complex, and the assessment of personality traits may be incorporated into a comprehensive psychosomatic evaluation of CRC patients. More well-designed prospective investigations are necessary to establish the contributory role of personality dimensions for the development of and protection from distress and impairment in the HRQoL of CRC patients, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population (for example, manual-based psychotherapies).
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Affiliation(s)
- Paulo M G Sales
- Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - André F Carvalho
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU) and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicholas Pavlidis
- Department of Medical Oncology, Medical School, University of Ioannina, Greece
| | - Thomas N Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Greece.
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Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg 2013; 257:672-8. [PMID: 23001075 DOI: 10.1097/sla.0b013e318269d03b] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Urinary and sexual dysfunctions are recognized complications of rectal cancer surgery. Their incidence after robotic surgery is as yet unknown. The aim of this study was to prospectively evaluate the impact of robotic surgery for rectal cancer on sexual and urinary functions in male and female patients. METHODS AND PROCEDURES From April 2008 to December 2010, 74 patients undergoing fully robotic resection for rectal cancer were prospectively included in the study. Urinary and sexual dysfunctions affecting quality of life were assessed with specific self-administered questionnaires in all patients undergoing robotic total mesorectal excision (RTME). Results were calculated with validated scoring systems and statistically analyzed. RESULTS The analyses of the questionnaires completed by the 74 patients who underwent RTME showed that sexual function and general sexual satisfaction decreased significantly 1 month after intervention: 19.1 ± 8.7 versus 11.9 ± 10.2 (P < 0.05) for erectile function and 6.9 ± 2.4 versus 5.3 ± 2.5 (P < 0.05) for general satisfaction in men; 2.6 ± 3.3 versus 0.8 ± 1.4 (P < 0.05) and 2.4 ± 2.5 versus 0.7 ± 1.6 (P < 0.05) for arousal and general satisfaction, respectively, in women. Subsequently, both parameters increased progressively, and 1 year after surgery, the values were comparable to those measured before surgery. Concerning urinary function, the grade of incontinence measured 1 year after the intervention was unchanged for both sexes. CONCLUSIONS RTME allows for preservation of urinary and sexual functions. This is probably due to the superior movements of the wristed instruments that facilitate fine dissection, coupled with a stable and magnified view that helps in recognizing the inferior hypogastric plexus.
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Dowson HM, Ballard K, Gage H, Jackson D, Williams P, Rockall TA. Quality of life in the first 6 weeks following laparoscopic and open colorectal surgery. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:367-372. [PMID: 23538189 DOI: 10.1016/j.jval.2012.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/02/2012] [Accepted: 11/15/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Evidence of how health-related quality of life (HRQOL) changes following laparoscopic and open colorectal surgery in the first 6 weeks of postoperative recovery is needed to inform cost-effectiveness evaluations. METHODS Pragmatic prospective cohort study design. Consecutive patients requiring elective colorectal surgery were allocated to either laparoscopic or open surgery by administrative staff in a district general hospital in England, 2006-2007. Patients completed two validated, generic measures of HRQOL at baseline (preoperatively) and on multiple occasions in the first 6 weeks postsurgery using diaries (EuroQol five-dimensional [EQ-5D] questionnaire: 16 times; short-form 36 health survey [SF-36]: 4 times; HRQOL was compared between groups at each time point, and overall using repeated-measures analysis. RESULTS Of 201 consecutive patients recruited, 32 (15.1%) were unable to complete diaries. Of the remaining 169 patients, 120 (71%) returned completed diaries at 28 days and 105 (62.1%) at 42 days. There was no difference in preoperative HRQOL scores between surgical groups, but the postoperative EQ-5D questionnaire and SF-36 scores were significantly higher in the laparoscopic group (EQ-5D questionnaire P = 0.005, SF-36 P = 0.007). Subgroup analysis showed that patients with a stoma have worse HRQOL than those without. HRQOL did not differ between the laparoscopic and open stoma patients. CONCLUSIONS This study presents unique prospective data demonstrating that laparoscopic surgery confers HRQOL benefits for patients in the early recovery period following colorectal surgery, compared with open surgery. Consideration of these data in the context of a cost-effectiveness analysis will be reported separately.
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Affiliation(s)
- Henry M Dowson
- Minimal Access Therapy Training Unit, Postgraduate Medical School, University of Surrey, Guildford, UK
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Breukink SO, Donovan KA. Physical and Psychological Effects of Treatment on Sexual Functioning in Colorectal Cancer Survivors. J Sex Med 2013; 10 Suppl 1:74-83. [DOI: 10.1111/jsm.12037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Krane MK, Fichera A. Laparoscopic rectal cancer surgery: Where do we stand? World J Gastroenterol 2012; 18:6747-55. [PMID: 23239912 PMCID: PMC3520163 DOI: 10.3748/wjg.v18.i46.6747] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 02/06/2023] Open
Abstract
Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach, whether the same oncologic clearance, specifically an adequate TME can be obtained is of concern. The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes. The data from 8 RCTs, 3 meta-analyses, and 2 Cochrane Database of Systematic Reviews was reviewed. Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss, earlier return of bowel function, and shorter hospital length of stay. Concerns that laparoscopic rectal cancer surgery compromises short-term oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature. Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.
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Prospective evaluation of health-related quality of life after laparoscopic colectomy for cancer. Tech Coloproctol 2012; 17:27-38. [DOI: 10.1007/s10151-012-0869-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 07/24/2012] [Indexed: 12/14/2022]
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Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y. Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Colorectal Dis 2012; 14:1231-7. [PMID: 22268662 DOI: 10.1111/j.1463-1318.2012.02956.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM A poor functional outcome is often reported after total mesorectal excision (TME) for rectal cancer, especially when sphincter-saving resection with intersphincteric dissection is performed for low tumours. Anal sphincter rehabilitation is widely proposed for faecal incontinence. Very few studies have reported results to improve anal dysfunction following rectal surgery. This prospective study aimed to assess the benefits of sphincter training after TME in terms of functional outcome and quality of life. METHODS Anal sphincter training was performed in patients undergoing laparoscopic sphincter-saving TME for rectal cancer. Rehabilitation was performed after ileostomy closure. This group was compared with 24 matched patients. Assessment included one functional and two quality of life questionnaires (SF-36 Health Status and Faecal Incontinence Quality of Life score). RESULTS From 2007 to 2009, 22 patients underwent laparoscopic TME. The median follow-up after stoma closure was 21.2 (range 8-46) months. The mean stool frequency per day was significantly lower after sphincter training (2.6 in the training group vs 4.0 in the control group, P=0.025). Following rehabilitation, patients complained significantly less about dyschezia (22 vs 63%, P=0.008). Both groups had similar continence (Wexner score 8.3 after training vs 9.9 in controls, NS). Quality of life was significantly improved by sphincter training as measured by the vitality (P=0.004) and mental functioning (P=0.02) subscales on the SF-36 Health Status questionnaire and by the depression and self-perception (P = 0.005) categories of the Faecal Incontinence Quality of Life score. CONCLUSION This study suggests that anal sphincter training following TME could decrease stool frequency and improve both general and specific quality of life.
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Affiliation(s)
- A Laforest
- Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Clichy, France
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Ragupathi M, Vande Maele D, Nieto J, Pickron TB, Haas EM. Transanal endoscopic video-assisted (TEVA) excision. Surg Endosc 2012; 26:3528-35. [PMID: 22729706 DOI: 10.1007/s00464-012-2399-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 05/15/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transanal endoscopic video-assisted (TEVA) excision represents an alternative approach for the surgical treatment of middle and upper rectal lesions not amenable to colonoscopic removal. Utilizing principles of single-incision laparoscopic surgery, this novel minimally invasive approach optimizes access for safe and complete removal of these lesions without the need for a formal rectal resection. We describe our technique and early outcomes with TEVA excision. METHODS Between March 2010 and September 2011, TEVA excision was performed for patients presenting for management of rectal lesions not amenable to colonoscopic or standard transanal removal. Patients were selected if they presented with benign disease or superficial adenocarcinoma, and the proximal extent of the lesion extended beyond 8 cm from the anal verge. Demographic, intraoperative, and postoperative data were assessed. A SILS™ port was placed in the anal canal for access in all cases. Standard laparoscopic instruments were utilized for visualization, full-thickness transanal excision, and primary closure. RESULTS Twenty patients (50% male) with a mean age of 64.6 ± 10.9 years, mean body mass index of 28.2 ± 4.9 kg/m(2), and median American Society of Anesthesiologist score of 2 underwent TEVA excision. Fourteen patients (70%) presented with benign disease and six patients (30%) presented with malignant disease. The mean size of the lesions was 3.0 ± 1.4 cm, and the mean distance from the anal verge was 10.6 ± 2.4 cm. All excisions were successfully completed with a mean operative time of 79.8 ± 25.1 (range, 45-135) min. The mean length of hospital stay was 1.1 ± 0.7 (range, 0-3) days. CONCLUSIONS TEVA excision is a safe and feasible approach for local excision of rectal lesions not otherwise amenable to standard techniques. Continued investigation and development will be important to establish its role in minimally invasive colorectal surgery.
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Robotic-assisted proctectomy for inflammatory bowel disease: a case-matched comparison of laparoscopic and robotic technique. J Gastrointest Surg 2012; 16:587-94. [PMID: 21964583 DOI: 10.1007/s11605-011-1692-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 09/13/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to compare short-term outcomes of robotic and laparoscopic proctectomy in patients with inflammatory bowel disease (IBD). METHODS This is an IRB-approved case-matched review. Seventeen robotic proctectomies (RP), 10 with ileal pouch anal anastomosis (IPAA) and 7 completion (CP), were matched to laparoscopic proctectomies (LP). Short-term and functional outcomes were compared between LP and RP. RESULTS In CP cohort, operative times were longer in the RP group (351 RP vs 238 LP min, p = 0.03), mean robotic time 90 min. Estimated blood loss (EBL) was similar between RP-CP and LP-CP groups (p = 0.18). Return of bowel function (RBF) was slower in RP-CP group (3.0 vs 1.7 days, p = 0.04), and length of stay (LOS) was longer (6.4 vs 4.1 days, p = 0.02). In the IPAA group, there were no differences between operative times (p = 0.14), robotic time 86 min; EBL (p = 0.15), and postoperative complications. Return of bowel function (3.6 vs 2.6 days, p = 0.3) and LOS (8.5 vs 6.1 days, p = 0.17) were similar between RP and LP. Bowel and sexual function were equivalent between LP and RP-IPAA groups. CONCLUSIONS Robotic proctectomy is a safe and effective technique for patients with IBD. It is comparable to LP with regard to perioperative outcomes, complications, and short-term functional results.
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Traa MJ, De Vries J, Roukema JA, Den Oudsten BL. Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 2012; 23:19-27. [PMID: 21508174 DOI: 10.1093/annonc/mdr133] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To determine (i) the prevalence of sexual (dys)function in patients with colorectal cancer and (ii) treatment-related and sociodemographic aspects in relation to sexual (dys)function and the quality of sexual life. Recommendations for future studies are provided. METHODS A systematic search was conducted during the period 1990 to July 2010 that used the databases PubMed, PsychINFO, The Cochrane Library, EMBASE, and OVID Medline. RESULTS Eighty-two studies were included. The mean quality score was 7.2. The percentage of preoperatively potent men that experienced sexual dysfunction postoperatively varied from 5% to 88%. Approximately half of the women reported sexual dysfunction. Preoperative radiotherapy, a stoma, complications during or after surgery, and a higher age predicted more sexual dysfunction with a strong level of evidence. Type of surgery and a lower tumor location predicted more sexual dysfunction with a moderate level of evidence. Insufficient evidence existed for predictors of the quality of sexual life. Current studies mainly focus on biological aspects of sexual (dys)function. Furthermore, existing studies suffer from methodological shortcomings such as a cross-sectional design, a small sample size, and the use of nonstandardized measurements. CONCLUSION Sexuality should be investigated prospectively from a biopsychosocial model, hereby including the quality of sexual life.
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Affiliation(s)
- M J Traa
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - J De Vries
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Medical Psychology
| | - J A Roukema
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Surgery
| | - B L Den Oudsten
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Education and Research, St Elisabeth Hospital, Tilburg, The Netherlands.
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Irani JL, Lowry AC. Postoperative Sexual Function. SEMINARS IN COLON AND RECTAL SURGERY 2011. [DOI: 10.1053/j.scrs.2011.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hyphantis T, Paika V, Almyroudi A, Kampletsas EO, Pavlidis N. Personality variables as predictors of early non-metastatic colorectal cancer patients' psychological distress and health-related quality of life: a one-year prospective study. J Psychosom Res 2011; 70:411-21. [PMID: 21511071 DOI: 10.1016/j.jpsychores.2010.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 09/02/2010] [Accepted: 09/28/2010] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We aimed to assess the course of early non-metastatic colorectal cancer patients' psychological distress and health-related quality of life (HRQOL) and to identify relevant clinical and psychological predictors during a one-year period. METHODS Of the 144 early non-metastatic colorectal cancer patients initially assessed for psychological distress symptoms (SCL-90-R), HRQOL (WHOQOL-BREF), sense of coherence (SOC), defense mechanisms (LSI) and hostility (HDHQ), 84 (58.3%) completed the one-year follow-up. Mean (SD) age was 65.1 (9.8) years and 67.4% were male. Mean (SD) disease duration was 1.7 (2.2) years, with 49.3% being diagnosed within the last six months. In 75.0% the site was at colon and in 25.0% at rectum; 2.1% had stage I, 59.0% stage II and 38.9% stage III disease. RESULTS Paranoid ideation, psychoticism, interpersonal sensitivity, anxiety and depressive symptoms increased significantly over the one-year period of the study and most of the HRQOL components were significantly decreased over the same period. Men were at greater risk for further developing depressive symptomatology. Low SOC was independent predictor of depression, while hostility independently predicted anxiety, interpersonal sensitivity and psychoticism symptoms. General psychological distress and low SOC were independent predictors of HRQOL, while repression was also an independent predictor of Physical HRQOL. CONCLUSIONS In early non-metastatic colorectal cancer patients, psychological distress symptoms are increased and HRQOL is decreased over one-year period. Symptoms of psychological distress are strong predictors of HRQOL, while personality variables can also predict psychological distress symptoms' increase and HRQOL decrease over time, and this could be relevant to psychological interventions.
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Affiliation(s)
- Thomas Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
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Abstract
In light of the improving prognosis for patients with rectal cancer, the quality of functional outcome has become increasingly important. Despite the good functional results achieved by expert surgeons, large multicenter studies show that urogenital dysfunction remains a common problem after rectal cancer treatment. More than half of patients experience a deterioration in sexual function, consisting of ejaculatory problems and impotence in men and vaginal dryness and dyspareunia in women. Urinary dysfunction occurs in one-third of patients treated for rectal cancer. Surgical nerve damage is the main cause of urinary dysfunction. Radiotherapy seems to have a role in the development of sexual dysfunction, without affecting urinary function. Pelvic autonomic nerves are especially at risk in cases of low rectal cancer and during abdominoperineal resection. Data concerning nerve damage during laparoscopic surgery for resection of rectal cancer are awaited. Structured education of surgeons with regard to pelvic neuroanatomy, and systematic registration of identified nerves, could well be the key to improving functional outcome for these patients. Meanwhile, patients should be informed of all associated risks before their operation, and their functional status should be evaluated before and after surgery.
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Affiliation(s)
- Marilyne M Lange
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Li J, Chen R, Xu YQ, Wang XC, Zheng S, Zhang SZ, Ding KF. Impact of a laparoscopic resection on the quality of life in rectal cancer patients: results of 135 patients. Surg Today 2010; 40:917-22. [PMID: 20872193 DOI: 10.1007/s00595-009-4156-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 07/23/2009] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the impact of a laparoscopic resection on the quality of life in rectal cancer patients. METHODS This study included 135 patients (laparoscopic resection [LR] 65 cases and open resection [OR] 70 cases). The European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires were used to measure the quality of life before the operation, then 1 week, 3 months, and 1 year after the operation. RESULTS Eleven (16.9%) patients underwent a conversion from laparoscopic to open surgery. The incision length and blood loss both decreased significantly in the LR group in comparison to the OR group (P < 0.05). Recovery of the gastrointestinal function, bladder function, and ambulation was more rapid in the LR group (P < 0.05). The patients in the LR group reported better global health status (33.3 vs 25.0, P < 0.001), body image (77.8 vs 66.7, P = 0.008), and less pain (33.3 vs 50. 0, P = 0.009) 1 week after operation. Better body image was reported in the LR group even 1 year after the operation (P < 0.05). Fewer financial difficulties were reported by patients in the LR group (P < 0.001). No significant differences were found between two groups on other scales. CONCLUSIONS This study showed that the quality of life benefits due to minimally invasive laparoscopic surgery were evident only in the immediate postoperative period. A laparoscopic rectal resection therefore provided only better cosmetic benefit over the longer term.
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Affiliation(s)
- Jun Li
- Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, No 88 Jiefang Road, Hangzhou, 310009 Zhejiang Province, PR China
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Safar B, Fleshman J. Laparoscopic Total Mesorectal Excision for Rectal Cancer. SEMINARS IN COLON AND RECTAL SURGERY 2010. [DOI: 10.1053/j.scrs.2010.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND The objective of the cross-sectional study reported here was to compare the quality of life of patients with an appropriate stoma site and with that of patients with an inappropriate stoma site. MATERIALS AND METHODS Two groups of patients with permanent intestinal stomas were assessed, 174 patients with appropriate stoma sites and 174 patients with inappropriate stoma sites. We used the EORTC QLQ-C30 and the EORTC QLQ-CR38, which evaluate 26 quality of life (QoL) scales. Data analysis was performed with SPSS software. RESULTS From a total of 9 functional scales, 3 scales in patients with an appropriate stoma site were significantly higher than in patients with an inappropriate stoma site: sexual enjoyment (71.2% vs. 63.2%; p = 0.02), physical functioning (74.3% vs. 68.2%; p = 0.005), and role functioning (74.3% vs. 64.4%; p < 0.0001). From the total of 16 symptom scales, patients with an inappropriate stoma site had significantly more problems than patients with an appropriate stoma site in 8 scales: micturation (27% vs. 22.5%; p = 0.04), gastrointestinal problems (32.6% vs. 27%; p = 0.01), weight loss (36.5% vs. 29.2%; p = 0.03), dyspnea (25.95% vs. 12.5%; p = 0.0001), pain (39.3% vs. 29.6%; p = 0.001), fatigue (43.5% vs. 34.5%; p < 0.0001), nausea and vomiting (18.15% vs. 12.8%; p = 0.03), and insomnia (39.8% vs. 31.1%; p = 0.01). Patients with an appropriate stoma site scored global QoL significantly higher than those with an inappropriate stoma site (56.2% vs. 49.7%; p = 0.007) CONCLUSIONS A perfectly placed intestinal stoma is strongly related to good QoL for affected patients. From the total of 26 QoL scales assessed in the study, patients with appropriate stoma sites achieved better results in at least 50% of the scales.
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Ellis R, Smith A, Wilson S, Warmington S, Ismail T. The Prevalence of Erectile Dysfunction in Post-Treatment Colorectal Cancer Patients and Their Interests in Seeking Treatment: A Cross-Sectional Survey in the West-Midlands. J Sex Med 2010; 7:1488-96. [DOI: 10.1111/j.1743-6109.2009.01461.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eveno C, Lamblin A, Mariette C, Pocard M. Sexual and urinary dysfunction after proctectomy for rectal cancer. J Visc Surg 2010; 147:e21-30. [PMID: 20587375 DOI: 10.1016/j.jviscsurg.2010.02.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Sexual and urinary dysfunction occur frequently after rectal surgery. Total mesorectal excision (TME) is currently the optimal technique for resection of rectal cancer, providing superior carcinological and functional outcomes. Age, pre-operative radiation therapy, abdominoperineal resection, and surgery which fails to respect the "sacred planes" of TME are the four major risk factors for post-operative sexual and urinary sequelae. In the era of TME, postoperative sexual dysfunction ranges from 10-35%, depending on the scores used to assess it, while urinary sequelae have decreased to less than 5%. The place of laparoscopic surgery remains to be defined, particularly with respect to these complications. It is essential to inform the patient pre-operatively about the possibility of such disorders not only for patient informed consent but also to help with correct post-operative management of the problem. Management is multifaceted, and includes psychological, pharmacological, and sometimes surgical therapy.
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Affiliation(s)
- C Eveno
- Département médicochirurgical de pathologie digestive, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
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Donovan KA, Thompson LMA, Hoffe SE. Sexual function in colorectal cancer survivors. Cancer Control 2010; 17:44-51. [PMID: 20010518 DOI: 10.1177/107327481001700106] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Findings from clinical and research studies suggest that the overall health-related quality of life of many colorectal cancer survivors is good. However, many survivors report significant sexual dysfunction after treatment that may adversely affect their quality of life in survivorship. METHODS This article examines studies investigating sexual function in men and women treated for colorectal cancer. Also included are data on the prevalence and nature of sexual dysfunctions in colorectal cancer survivors, the impact of specific treatment modalities for colorectal cancer on sexual function, and the management of sexual dysfunction in men and women. RESULTS Published studies investigating sexual dysfunction after colorectal cancer treatment generally have been limited conceptually and methodologically. However, findings suggest that the prevalence of sexual dysfunction among colorectal cancer survivors is high. CONCLUSIONS Sexual dysfunction is often a long-term and late effect of treatment for colorectal cancer. The assessment and management of sexual dysfunction in men and women treated for colorectal cancer should be standard practice throughout treatment and in survivorship.
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Affiliation(s)
- Kristine A Donovan
- Psychosocial and Palliative Care Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida 33612, USA.
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Prospective evaluation of sexual function after open and laparoscopic surgery for rectal cancer. Surg Endosc 2009; 23:2665-74. [DOI: 10.1007/s00464-009-0507-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Revised: 03/29/2009] [Accepted: 04/18/2009] [Indexed: 10/20/2022]
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Dowson HM, Cowie AS, Ballard K, Gage H, Rockall TA. Systematic Review of Quality of Life following Laparoscopic and open colorectal surgery. Colorectal Dis 2008; 10:757-68. [PMID: 18573115 DOI: 10.1111/j.1463-1318.2008.01603.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the health-related quality of life (HRQoL) of patients following laparoscopic and open colorectal surgery. METHODS A systematic review was performed according to Quorum guidelines. Prospective studies comparing the HRQoL of patients after laparoscopic and open colorectal surgery were identified. The primary outcome measure was postoperative quality of life; performance status and cosmesis were secondary outcome measures. RESULTS 23 studies were identified that satisfied the inclusion criteria; 18 assessed HRQoL, 4 performance status, and 3 cosmesis. It was not possible to perform a meta-analysis due to study heterogeneity. The studies reported outcomes for 2946 patients. The most frequent HRQoL instruments employed were SF-36, EORTC, and GIQLI. 6 studies, using a total of 12 separate measures, evaluated QoL during the first 3 post-operative months: 10 of these measures showed no significant difference, and 2 showed an improved HRQoL with laparoscopy. Twelve further studies evaluated HRQoL up to 5 years post-operatively: 9 showed no difference between the 2 groups, and 3 demonstrated a benefit for laparoscopy. Three of 4 studies assessing performance status on discharge, and all 3 studies assessing cosmesis, reported benefits with the laparoscopic approach. CONCLUSIONS The current evidence suggests there is no significant difference in HRQoL following laparoscopic and open colorectal surgery, although there is a lack of good quality data. There is a trend towards improved quality of life outcomes and performance status with laparoscopy in the early post-operative period. There is a need for further research, particularly assessing quality of life in the early post-operative period.
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Affiliation(s)
- H M Dowson
- Minimal Access Therapy Training Unit, Postgraduate Medical School, Manor Park, Guildford, Surrey, UK.
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Perera MTPR, Deen KI, Wijesuriya SRE, Kumarage SK, De Zylva STU, Ariyaratne MHJ. Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy. Colorectal Dis 2008; 10:689-93. [PMID: 18294269 DOI: 10.1111/j.1463-1318.2008.01486.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. METHOD Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). RESULTS More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial.
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Affiliation(s)
- M T P R Perera
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
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The Effect of Colorectal Surgery in Female Sexual Function, Body Image, Self-Esteem and General Health: A Prospective Study. Ann Surg 2008; 248:266-72. [DOI: 10.1097/sla.0b013e3181820cf4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Murata A, Brown CJ, Raval M, Phang PT. Impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer. Am J Surg 2008; 195:611-5; discussion 615. [DOI: 10.1016/j.amjsurg.2007.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 12/17/2007] [Accepted: 12/17/2007] [Indexed: 11/26/2022]
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Hassan I, Cima RR. Quality of life after rectal resection and multimodality therapy. J Surg Oncol 2008; 96:684-92. [PMID: 18081167 DOI: 10.1002/jso.20916] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Modern management of locally advanced rectal cancer requires a multimodality approach. This includes radical surgery, pelvic radiotherapy, and systemic chemotherapy. It can require a permanent colostomy and result in significant bowel, sexual, and urinary dysfunction. In order to determine the effectiveness of various multimodality regimens it is important to not only assess conventional oncologic outcomes but also the impact on patient's quality of life.
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Affiliation(s)
- Imran Hassan
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois 62704, USA.
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Gervaz P, Bucher P, Konrad B, Morel P, Beyeler S, Lataillade L, Allal A. A Prospective longitudinal evaluation of quality of life after abdominoperineal resection. J Surg Oncol 2008; 97:14-19. [DOI: 10.1002/jso.20910] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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