Restorative reconstruction after total mesorectal excision for rectal cancer is associated with significant bowel dysfunction from initial presentation

Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients

Rectal cancer treatment often encompasses multiple steps and options, with benefits and risks that vary based on the individual. Additionally, patients facing rectal cancer often have preferences regarding overall quality of life, which includes bowel function, sphincter preservation, and ostomies. This article reviews these data in the context of shared decision-making approaches in an effort to better inform patients deliberating treatment options for rectal cancer.

Patient reported outcome measures (PRO) in colorectal surgery

Patient reported outcomes refer to, "Any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else" (US Food and Drug Administration, 2009) [1]. These outcomes can include anything that matters to patients including quality of life, pain, number of bowel movements. Patient reported outcome measures refer to tools or instruments that help to measure these outcomes. These measures can be done using validated tools, those that have undergone rigorous testing and psychometric validation, and non-validated tools such as may exist in a practice to rate practice or physician/staff care quality. For this paper, we will discuss the role of patient reported outcomes measures in colon and rectal surgery.

Long-term bowel function patient-reported outcomes after successful chemoradiation for carcinoma of the anal canal

AIM

We aimed to evaluate long-term changes in patient-reported bowel function from presentation of anal canal squamous cell carcinoma (SCC) successfully treated with the modified Nigro protocol using a patient-reported outcome measure for bowel function.

METHOD

This is a retrospective study of prospectively collected patient-reported outcomes for bowel function. We included patients that were successfully treated with the modified Nigro protocol for anal SCC and had completed the Colorectal Functional Outcomes (COREFO) questionnaire at presentation, following the modified Nigro treatment (post-Nigro), and at subsequent surveillance visits (medium and long term). We compared the differences in mean domain and total COREFO scores using a paired t test for each paired time point.

RESULTS

Twenty-seven patients met inclusion criteria. Time from completion of the modified Nigro was post-Nigro at 3-6 months, medium-length follow-up at 8-12 months and long-term follow-up at 12-18 months. There was significant improvement in the stool-related aspects domain (pain, bleeding and anal skin irritation) from presentation to our short- and medium-length follow-up (42.5 to 23.7, P = 0.01). There was worsening in the frequency domain in the medium term (7.23 to 14.5, P = 0.02). There were no differences in any other domain or time point.

CONCLUSION

Global bowel function does not appear to change following successful treatment of anal canal SCC with the modified Nigro protocol in the long term. There are some improvements in stool-related aspects and worsening in bowel movement frequency at medium-length follow-up. These findings should help surgeons counsel patients with regard to bowel function expectations for those with anal canal SCC in the long term.