1
|
Ghomeshi A, Zizzo J, Reddy R, White J, Swayze A, Swain S, Ramasamy R. The erectile and ejaculatory implications of the surgical management of rectal cancer. Int J Urol 2023; 30:827-837. [PMID: 37365839 DOI: 10.1111/iju.15235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
Colorectal cancer is a significant cause of cancer-related deaths worldwide. Although advances in surgical technology and technique have decreased mortality rates, surviving patients often experience sexual dysfunction as a common complication. The development of the lower anterior resection has greatly decreased the use of the radical abdominoperineal resection surgery, but even the less radical surgery can result in sexual dysfunction, including erectile and ejaculatory dysfunction. Improving the knowledge of the underlying causes of sexual dysfunction in this context and developing effective strategies for preventing and treating these adverse effects are essential to improving the quality of life for postoperative rectal cancer patients. This article aims to provide a comprehensive evaluation of erectile and ejaculatory dysfunction in postoperative rectal cancer patients, including their pathophysiology and time course and strategies for prevention and treatment.
Collapse
Affiliation(s)
- Armin Ghomeshi
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - John Zizzo
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Raghuram Reddy
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Joshua White
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aden Swayze
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
2
|
Lin Y, Kou S, Nie H, Luo H, Eltahir A, Chapman W, Hunt S, Mutch M, Zhu Q. Deep learning based on co-registered ultrasound and photoacoustic imaging improves the assessment of rectal cancer treatment response. Biomed Opt Express 2023; 14:2015-2027. [PMID: 37206148 PMCID: PMC10191638 DOI: 10.1364/boe.487647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 05/21/2023]
Abstract
Identifying complete response (CR) after rectal cancer preoperative treatment is critical to deciding subsequent management. Imaging techniques, including endorectal ultrasound and MRI, have been investigated but have low negative predictive values. By imaging post-treatment vascular normalization using photoacoustic microscopy, we hypothesize that co-registered ultrasound and photoacoustic imaging will better identify complete responders. In this study, we used in vivo data from 21 patients to develop a robust deep learning model (US-PAM DenseNet) based on co-registered dual-modality ultrasound (US) and photoacoustic microscopy (PAM) images and individualized normal reference images. We tested the model's accuracy in differentiating malignant from non-cancer tissue. Compared to models based on US alone (classification accuracy 82.9 ± 1.3%, AUC 0.917(95%CI: 0.897-0.937)), the addition of PAM and normal reference images improved the model performance significantly (accuracy 92.4 ± 0.6%, AUC 0.968(95%CI: 0.960-0.976)) without increasing model complexity. Additionally, while US models could not reliably differentiate images of cancer from those of normalized tissue with complete treatment response, US-PAM DenseNet made accurate predictions from these images. For use in the clinical settings, US-PAM DenseNet was extended to classify entire US-PAM B-scans through sequential ROI classification. Finally, to help focus surgical evaluation in real time, we computed attention heat maps from the model predictions to highlight suspicious cancer regions. We conclude that US-PAM DenseNet could improve the clinical care of rectal cancer patients by identifying complete responders with higher accuracy than current imaging techniques.
Collapse
Affiliation(s)
- Yixiao Lin
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Sitai Kou
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Haolin Nie
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Hongbo Luo
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
| | - Ahmed Eltahir
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Will Chapman
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Steven Hunt
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew Mutch
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63105, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| |
Collapse
|
3
|
Grüter AAJ, van Lieshout AS, van Oostendorp SE, Ket JCF, Tenhagen M, den Boer FC, Hompes R, Tanis PJ, Tuynman JB. Required distal mesorectal resection margin in partial mesorectal excision: a systematic review on distal mesorectal spread. Tech Coloproctol 2023; 27:11-21. [PMID: 36036328 DOI: 10.1007/s10151-022-02690-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The required distal margin in partial mesorectal excision (PME) is controversial. The aim of this systematic review was to determine incidence and distance of distal mesorectal spread (DMS). METHODS A systematic search was performed using PubMed, Embase and Google Scholar databases. Articles eligible for inclusion were studies reporting on the presence of distal mesorectal spread in patients with rectal cancer who underwent radical resection. RESULTS Out of 2493 articles, 22 studies with a total of 1921 patients were included, of whom 340 underwent long-course neoadjuvant chemoradiotherapy (CRT). DMS was reported in 207 of 1921 (10.8%) specimens (1.2% in CRT group and 12.8% in non-CRT group), with specified distance of DMS relative to the tumor in 84 (40.6%) of the cases. Mean and median DMS were 20.2 and 20.0 mm, respectively. Distal margins of 40 mm and 30 mm would result in 10% and 32% residual tumor, respectively, which translates into 1% and 4% overall residual cancer risk given 11% incidence of DMS. The maximum reported DMS was 50 mm in 1 of 84 cases. In subgroup analysis, for T3, the mean DMS was 18.8 mm (range 8-40 mm) and 27.2 mm (range 10-40 mm) for T4 rectal cancer. CONCLUSIONS DMS occurred in 11% of cases, with a maximum of 50 mm in less than 1% of the DMS cases. For PME, substantial overtreatment is present if a distal margin of 5 cm is routinely utilized. Prospective studies evaluating more limited margins based on high-quality preoperative magnetic resonance imaging and pathological assessment are required.
Collapse
|
4
|
Vatandoust S, Wattchow D, Sposato L, Michael MZ, Leung J, Gormly K, Chen G, Symonds EL, Tie J, Papanicolas LE, Woods S, Gebski V, Mead K, Kuruni A, Karapetis CS. A longitudinal cohort study of watch and wait in complete clinical responders after chemo-radiotherapy for localised rectal cancer: study protocol. BMC Cancer 2022; 22:222. [PMID: 35232427 PMCID: PMC8887187 DOI: 10.1186/s12885-022-09304-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
Background Rectal Cancer is a common malignancy. The current treatment approach for patients with locally advanced rectal cancer involves neoadjuvant chemoradiotherapy followed by surgical resection of the rectum. The resection can lead to complications and long-term consequences. A clinical complete response is observed in some patients after chemoradiotherapy. A number of recent studies have shown that patients can be observed safely after completing chemoradiotherapy (without surgery), provided clinical complete response has been achieved. In this approach, resection is reserved for cases of regrowth. This is called the watch and wait approach. This approach potentially avoids unnecessary surgical resection of the rectum and the resulting complications. In this study, we will prospectively investigate this approach. Methods Adult patients with a diagnosis of rectal cancer planned to receive neoadjuvant long course chemoradiotherapy (± subsequent combination chemotherapy) will be consented into the study prior to commencing treatment. After completing the chemoradiotherapy (± subsequent combination chemotherapy), based on the clinical response, subjects will be allocated to one of the following arms: subjects who achieved a clinical complete response will be allocated to the watch and wait arm and others to the standard management arm (which includes resection). The aim of the study is to determine the rate of local failure and other safety and efficacy outcomes in the watch and wait arm. Patient reported outcome measures and the use of biomarkers as part of the clinical monitoring will be studied in both arms of the study. Discussion This study will prospectively investigate the safety of the watch and wait approach. We will investigate predictive biomarkers (molecular biomarkers and imaging biomarkers) and patient reported outcome measures in the study population and the cost effectiveness of the watch and wait approach. This study will also help evaluate a defined monitoring schedule for patients managed with the watch and wait approach. This protocol covers the first two years of follow up, we are planning a subsequent study which covers year 3–5 follow up for the study population. Trial registration. Name of the registry: Australia and New Zealand Clinical Trials Registry (ANZCTR). Trial registration number: Trial ID: ACTRN12619000207112 Registered 13 February 2019,https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376810 Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09304-x.
Collapse
Affiliation(s)
- Sina Vatandoust
- Flinders Medical Centre, Adelaide, Australia. .,Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia.
| | - David Wattchow
- Flinders Medical Centre, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Luigi Sposato
- Flinders Medical Centre, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Michael Z Michael
- Flinders Medical Centre, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - John Leung
- Flinders Medical Centre, Adelaide, Australia.,GenesisCare, Adelaide, Australia
| | - Kirsten Gormly
- Dr Jones & Partners Medical Imaging, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Gang Chen
- Monash University, Melbourne, Australia
| | - Erin L Symonds
- Flinders Medical Centre, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Jeanne Tie
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Lito Electra Papanicolas
- Flinders Medical Centre, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Susan Woods
- University of Adelaide, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Kelly Mead
- Flinders Medical Centre, Adelaide, Australia
| | | | - Christos S Karapetis
- Flinders Medical Centre, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia
| |
Collapse
|
5
|
Intini G, Tierno SM, Farina M, Lirici MM, Lucandri G, Mezzetti G, Pende V, Pernazza G, Stipa F, Vitelli CE. Functional results after mesorectal excision for rectal cancer: comparative study among surgical approaches. Minerva Surg 2022; 77:318-326. [PMID: 35175013 DOI: 10.23736/s2724-5691.22.08803-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We analyzed the evolution of genitourinary dysfunctions in patients undergoing surgical treatment for rectal cancer, and compared open surgery, laparoscopy, robotic and TaTME. METHODS Functional outcomes were evaluate using standardized questionnaires, compiled at the start of treatment, after the end of Radiotherapy, at 1 and 6 months after surgery. RESULTS In 72 patients 37.5% had low, 27.8% middle, and 34.7% high rectal cancers. Open technique was performed in 25% of cases, while 29.2% underwent laparoscopy, 20.8% TaTME and 25% robotic. We noted a deterioration in urogenital function: surgical technique can influence the result both in urinary and male sexual function but not ejaculation. Robotics and laparoscopy bring better outcomes than open surgery and TaTME. Female sexuality worsening seems not influenced by the technique. In general age, stage, complications and anastomotic leakage appear to be predictive factors for functional dysfunctions. As reported in literature rectal cancer treatment leads to urogenital worsening: this seems to be progressive in male sexuality only, while female one and urinary function show a slight improvement in the first months, although a full recovery possibility is discussed. Is also reported how robotic and laparoscopy have a lower functional impact. TaTME has gained consensus thank to the excellent oncological and function outcomes, but in our study leads to worse results. CONCLUSIONS Mini-invasive techniques guarantee the same oncological result than more invasive ones, but with better functional outcomes and tolerability; robotic surgery seems to be slight superior than laparoscopy, but with longer operative time.
Collapse
Affiliation(s)
- Gianfrancesco Intini
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy -
| | - Simone M Tierno
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Massimo Farina
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Marco M Lirici
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Giorgio Lucandri
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Giuseppe Mezzetti
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Vito Pende
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Graziano Pernazza
- Department of Surgery, General and Robotic Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Francesco Stipa
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Carlo E Vitelli
- Department of Surgery, General and Oncological Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| |
Collapse
|
6
|
Lee TH, Kwak JM, Yu DY, Yang KS, Baek SJ, Kim J, Kim SH. Lower Incidence of Postoperative Urinary Retention in Robotic Total Mesorectal Excision for Low Rectal Cancer Compared with Laparoscopic Surgery. Dig Surg 2022; 39:75-82. [PMID: 35130545 DOI: 10.1159/000522229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/14/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The incidence and clinical significance of postoperative urinary retention (POUR) remain high. This study aimed to evaluate the incidence of POUR and related risk factors in patients who underwent total mesorectal excision (TMR) for low rectal cancer. METHODS This study is a retrospective review of a prospectively collected colorectal database from a single center. Data from patients who underwent surgery for low rectal cancer between September 2006 and May 2017 were analyzed to assess the risk factors of POUR. POUR was considered inability to void after urinary catheter removal requiring catheter reinsertion and difficulty in bladder emptying requiring intermittent catheterization. RESULTS Of 555 patients with low rectal cancer, 78 (14.1%) developed POUR. Based on multivariate logistic regression analysis, laparoscopic TMR (odds ratio [OR]; 2.114, 95% confidence interval [CI]; 1.212-3.689, p = 0.008) and postoperative ileus (OR; 2.389, 95% CI; 1.282-4.450, p = 0.006) were independent risk factors of POUR. Male gender, advanced age, neoadjuvant chemoradiation, longer operative time, abdominoperineal resection, and lateral pelvic lymph node dissection were not associated with POUR. Advanced age over 65 years also failed to show statistical significance (OR; 1.604, 95% CI; 0.965-2.668, p = 0.068). CONCLUSION Laparoscopic approach and postoperative ileus are risk factors for POUR after low rectal cancer surgery. We postulate that the benefits of robotic surgical systems compared to a laparoscopic approach may reduce the incidence of POUR.
Collapse
Affiliation(s)
- Tae Hoon Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Da Young Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Se Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seon Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
7
|
Ortega MV, Bordeianou L. Sexual and urinary dysfunction after proctectomy with or without abdominoperineal resection: Incidence and treatment. Seminars in Colon and Rectal Surgery 2021; 32:100848. [DOI: 10.1016/j.scrs.2021.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Holmgren K, Häggström J, Haapamäki MM, Matthiessen P, Rutegård J, Rutegård M. Defunctioning stomas may reduce chances of a stoma-free outcome after anterior resection for rectal cancer. Colorectal Dis 2021; 23:2859-2869. [PMID: 34310840 DOI: 10.1111/codi.15836] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 12/30/2022]
Abstract
AIM To investigate the conflicting consequences of faecal diversion on stoma outcomes and anastomotic leakage in anterior resection for rectal cancer, including interaction effects determined by the extent of mesorectal excision. METHOD Anterior resections between 2007 and 2016 were identified using the Swedish Colorectal Cancer Registry. National Patient Registry data were added to determine stoma outcome 2 years after surgery. Tumour distance from the anal verge constituted a proxy for extent of mesorectal excision [total mesorectal excision (TME): ≤10 cm; partial mesorectal excision (PME): 13-15 cm]. With confounder-adjusted probit regression, the total effect of defunctioning stoma on permanent stoma, and the interaction effect of extent of mesorectal excision, were estimated together with the indirect effect through anastomotic leakage. Baseline risks, risk differences (RDs) and relative risks (RRs) were reported. RESULTS The main study cohort included 4529 patients. Defunctioning stomas influenced the absolute permanent stoma risk (TME: RD 0.11 [95% CI 0.09-0.13]; PME: RD 0.15 [95% CI 0.13-0.16]). The baseline risk was higher in TME, with a resulting greater RR in PME (2.23 [95% CI 1.43-3.02] vs 4.36 [95% CI 3.05-5.68]). The indirect reduction in permanent stoma rates, due to the alleviating effect of faecal diversion on anastomotic leakage, was small (TME: 0.89 [95% CI 0.81-0.96]; PME: 0.96 [95% CI 0.91-1.00]). CONCLUSION In anterior resection for rectal cancer, defunctioning stomas may reduce chances of a stoma-free outcome. Considering leakage reduction benefits, consequences of routine diversion in TME might be fairly balanced, while this seems questionable in PME.
Collapse
Affiliation(s)
- Klas Holmgren
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Jenny Häggström
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Markku M Haapamäki
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Peter Matthiessen
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Jörgen Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
9
|
Pascual-Russo A, Milito D, Facio L, Furia M, Forestier V, Iseas S, Méndez G, Coraglio M, Lumi CM, Masciangioli G, Mauriño E, Vázquez H. Better quality of life and reduced fecal incontinence in rectal cancer patients with the watch-and-wait follow-up strategy. Rev Gastroenterol Mex (Engl Ed) 2021; 86:340-347. [PMID: 34247991 DOI: 10.1016/j.rgmxen.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/06/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The watch-and-wait (WW) strategy is an alternative to anterior resection in patients with rectal cancer (RC) that have had a complete clinical response to neoadjuvant treatment. Few reports describe the quality of life and functional anorectal disorders (FADs) in that population. AIM To analyze and compare the FADs and quality of life in patients with locally advanced adenocarcinoma of the rectum treated with neoadjuvant therapy, divided into two different strategy groups: group 1 (G1), WW; and group 2 (G2), anterior resection. MATERIALS AND METHODS Thirty patients (G1: n = 20 and G2: n = 10) that had finished neoadjuvant therapy at least 12 months prior were included. Mean patient age was 59.5 years (range: 41-79) and 15 of the patients were men. The FADs were evaluated through: a) clinical history, b) 21-day bowel diary, c) Jorge and Wexner fecal incontinence scale, d) anorectal manometry (ARM), and fecal incontinence quality of life scale (FIQL). RESULTS Bowel diary: fecal incontinence (40%) and urge to defecate (45%) in G1 vs. fecal incontinence (60%) and urge to defecate (30%) in G2, with no significant differences (p = NS). Fecal incontinence scale: fecal incontinence in G1 was significantly less severe than that in G2 (median 6.5 points vs. 13 points [p = 0.0142]). ARM: no differences between the two groups. Quality of life: significantly different between the two groups (FIQL/G1: 3.7 vs. FIQL/G2: 2.8; p < 0.03). CONCLUSIONS The WW follow-up strategy in patients with locally advanced rectal cancer was associated with better quality of life and reduced fecal incontinence.
Collapse
Affiliation(s)
- A Pascual-Russo
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina.
| | - D Milito
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - L Facio
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Furia
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - V Forestier
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - S Iseas
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Méndez
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Coraglio
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - C M Lumi
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Masciangioli
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - E Mauriño
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - H Vázquez
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina; Investigador Asociado, Gobierno de la Ciudad de Buenos Aires, CABA, Argentina
| |
Collapse
|
10
|
Kondo A, Nishizawa Y, Tsukada Y, Sasaki T, Inoue M, Masuda H, Suzuki Y, Ito M. Potential benefit of laparoscopic surgery for rectal cancer on postoperative male sexual function. Colorectal Dis 2021; 23:1745-1754. [PMID: 33715303 DOI: 10.1111/codi.15626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/03/2021] [Accepted: 03/05/2021] [Indexed: 12/21/2022]
Abstract
AIM The aim of this retrospective study was to evaluate the incidence of male sexual dysfunction after mid to low rectal cancer surgery and to identify factors associated with postoperative erectile and ejaculatory dysfunction. METHODS The subjects were 410 consecutive male patients who underwent surgery for mid to low rectal cancer from 2009 to 2015. Two questionnaires on sexual function were administered: the International Index of Erectile Function, and an original questionnaire on ejaculatory status. Erectile and ejaculatory dysfunction were examined before and 3, 6, 12 months after surgery. In patients without preoperative dysfunction, multivariate regression analyses were performed to identify factors associated with the incidence of erectile and ejaculatory dysfunction at 12 months after surgery. RESULTS Of 410 patients, 234 (57%) gave complete responses to the questionnaires, of whom 108 (46%) and 155 (66%) had severe erectile dysfunction, while 115 (49%) and 168 (72%) had severe ejaculatory dysfunction before and 12 months after surgery, respectively. Of the patients who maintained sexual function preoperatively, the incidence of erectile and ejaculatory dysfunction at 12 months after surgery was 51% (64/126) and 49% (58/119), respectively. In multivariate analysis, age >60 years (P = 0.02), laparotomy (P = 0.002), and creation of a diverting ileostomy (P = 0.003) were independent factors associated with postoperative erectile dysfunction, while age >60 years (P = 0.005), laparotomy (P = 0.04), and lateral lymph node dissection (P = 0.001) were independent factors associated with postoperative ejaculatory dysfunction. CONCLUSION Sexual dysfunction occurred in almost half of patients after rectal cancer surgery, and was independently associated with several factors, including laparotomy.
Collapse
Affiliation(s)
- Akihiro Kondo
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.,Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Masaharu Inoue
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
11
|
Mamlin M, Midlenko A, Khamzina S, Mukazhanov A. Massive Retroperitoneal and Subcutaneous Emphysema after Transanal Excision of Rectal Cancer. Case Rep Oncol 2021; 14:922-927. [PMID: 34248559 PMCID: PMC8255724 DOI: 10.1159/000516757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022] Open
Abstract
Transanal excision (TAE) is considered a safe, alternative approach for patients with early stage of rectal cancer. Complications associated with TAE are rare, such as bleeding, perforation, incontinence, and rectal stricture. Subcutaneous emphysema is early complication of laparoscopic surgery, common during upper gastrointestinal and gynecological surgery. We report a case of retroperitoneal and subcutaneous emphysema emerging after TAE of rectal tumor. The patient presented with changed bowel habits. Colonoscopy with pathology reports, ultrasound, and magnetic resonance imaging showed an adenocarcinoma in the rectum at a 5 cm from the anus and did not reveal signs of invasive growth, pathologic lymph nodes, or systemic metastases. After surgery patient complained about abdominal pain and severe subcutaneous emphysema. Computed tomography showed retroperitoneal emphysema with no signs of rectal wall defect. He received antibiotics and was kept hospitalized with a solid diet and the retroperitoneal air disappeared on the thoracic X-ray. Patients who remain clinically stable or steadily improving without signs if peritonitis can be managed conservatively. Only in case of ineffectiveness of conservative therapy, undergo surgery.
Collapse
Affiliation(s)
- Meiram Mamlin
- Department of Surgery, National Research Oncology Center, Nur-Sultan, Kazakhstan
| | - Anna Midlenko
- Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
| | - Saule Khamzina
- Department of Surgery, National Research Oncology Center, Nur-Sultan, Kazakhstan
| | - Adilbek Mukazhanov
- Department of hepatology, gastroenterology and organ transplantation, National Research Oncology Center, Nur-Sultan, Kazakhstan
| |
Collapse
|
12
|
Torrijo I, Balciscueta Z, Tabet J, Martín MC, López M, Uribe N. Prospective study of sexual function and analysis of risk factors after rectal cancer surgery. Colorectal Dis 2021; 23:1379-1392. [PMID: 33599035 DOI: 10.1111/codi.15589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/20/2022]
Abstract
AIM The aim of this study was to assess the evolution of sexual function over time after rectal cancer surgery and to identify risk factors that may have an impact on the deterioration of postoperative function. METHOD This was a prospective cohort study of sexual function after rectal cancer surgery using the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) preoperatively and at 6 and 12 months after surgery. Predictive factors of worsening were identified by univariate and multivariate analysis. RESULTS One hundred and one patients were included (56 men and 45 women). In men, the average IIEF showed decreased erectile function and intercourse satisfaction at 6 months (respectively 21.58 ± 7.18 to 16.60 ± 7.96, p = 0.002 and 10.87 ± 2.94, to 8.09 ± 4.45, p = 0.002) with recovery at 1 year. As a percentage, erectile dysfunction increased from the preoperative value to 6 months (64.5% vs 87.1%, p = 0.022) and was observed in 72% at 1 year. Patients with moderate to severe dysfunction increased from 22% preoperatively to 58% (p = 0.009) at 6 months and 44% at 1 year (p < 0.0001). Neoadjuvant chemoradiotherapy (OR 5.4, 95% CI 0.9-29.6; p = 0.041) and erectile worsening at 6 months (OR 20, 95% CI 1.6-238; p = 0.004) were independent factors for worse function at 6 or 12 months, respectively. No significant worsening of the FSFI was found, although there was an improvement in lubrication and orgasm. CONCLUSION Temporary deterioration of erectile function in men is common at 6 months after surgery and chemoradiotherapy is the only predictive factor. Furthermore, patients who remain dysfunctional show an increase in the severity of symptoms in relation to the preoperative period.
Collapse
Affiliation(s)
- Inmaculada Torrijo
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Zutoia Balciscueta
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Janine Tabet
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - M Carmen Martín
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Manuel López
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Natalia Uribe
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| |
Collapse
|
13
|
Torrijo I, Balciscueta Z, Tabet J, Martín MC, López M, Uribe N. Prospective study of urinary function and analysis of risk factors after rectal cancer surgery. Tech Coloproctol 2021; 25:727-737. [PMID: 33811298 DOI: 10.1007/s10151-021-02445-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Alterations in urinary function are complications of rectal cancer surgery. The aim of this study was to prospectively analyze the changes in urinary function in patients operated on for rectal cancer, and to identify risk factors that may have an impact on the deterioration of postoperative urinary function. METHODS A prospective study of urinary function in rectal cancer patients who had elective oncological resection with curative intention at the Arnau de Vilanova Hospital in Valencia, Spain, from January 2017 to March 2019. The evaluation of urinary function was performed using the International Prostate Symptom Score (IPSS) preoperatively, at 6 and 12 months after surgery. Predictive factors of urinary dysfunction were identified by univariate and multivariate analysis. RESULTS Ninety-four patients were enrolled in the study. Eighty-seven of them completed all the follow-up assessments (48 men and 39 women, mean age 65.74 ± 10.95 years,). The mean IPSS was 7.96 ± 7.59 preoperatively, 9.01 ± 6.81 at 6 months, and 8.63 ± 5.59 at 12 months, without statistically significant differences. There were no differences in IPSS between males and females. Preoperative urinary dysfunction was 39% and at 12 months, a deterioration occurred in 23 patients (26.4%). IPSS analysis of symptoms showed a statistically significant worsening of nocturia at 6 months (p = 0.002) and 1 year after surgery (p = 0.037) in women. American Society of Anesthesiologists (ASA) class (OR: 11, [95% CI2.4-53]; p = 0.010), surgical difficulty (OR: 4.5, [95% CI 1-19]; p = 0.027) and anastomotic leakage (OR: 14, [95% CI 1.6-117]; p = 0.010), were identified as independent risk factors for deterioration of urinary function after surgery. CONCLUSIONS Our study showed worsening urinary dysfunction after rectal cancer surgery in 26.4% of the patients. However, there were no statistically significant differences in mean IPSS scores at the three assessment times (preoperatively, 6 months, 12 months). ASA class, surgical difficulty, and anastomotic leakage may predict postoperative deterioration.
Collapse
Affiliation(s)
- I Torrijo
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain.
| | - Z Balciscueta
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - J Tabet
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M C Martín
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M López
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - N Uribe
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| |
Collapse
|
14
|
Abstract
Abstract
Introduction Over the last decades, treatment for rectal cancer has substantially improved with development of new surgical options and treatment modalities. With the improvement of survival, functional outcome and quality of life are getting more attention.
Study objective To provide an overview of current modalities in rectal cancer treatment, with particular emphasis on functional outcomes and quality of life.
Results Functional outcomes after rectal cancer treatment are influenced by patient and tumor characteristics, surgical technique, the use of preoperative radiotherapy and the method and level of anastomosis. Sphincter preserving surgery for low rectal cancer often results in poor functional outcomes that impair quality of life, referred to as low anterior resection syndrome. Abdominoperineal resection imposes the need for a permanent stoma but avoids the risk of this syndrome. Contrary to general belief, long-term quality of life in patients with a permanent stoma is similar to those after sphincter preserving surgery for low rectal cancer.
Conclusion All patients should be informed about the risks of treatment modalities. Decision on rectal cancer treatment should be individualized since not all patients may benefit from a sphincter preserving surgery “at any price”. Non-resection treatment should be the future focus to avoid the need of a permanent stoma and bowel dysfunction.
Collapse
Affiliation(s)
- Pedro Campelo
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Elisabete Barbosa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
- Centro Hospitalar São João, Departamento de Cirurgia Colorretal, Porto, Portugal
| |
Collapse
|
15
|
Laurberg JR, Laurberg VR, Elfeki H, Jensen JB, Emmertsen KJ. Male erectile function after treatment for colorectal cancer: a population-based cross-sectional study. Colorectal Dis 2021; 23:367-375. [PMID: 33306262 DOI: 10.1111/codi.15482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
Abstract
AIM The aim of this work was to determine the knowledge gap in the field of erectile function (EF) after colorectal cancer surgery and investigate and compare long-term male EF in colon and rectal cancer survivors in a national population. METHOD Danish male patients alive without evidence of recurrence who were treated for colon or rectal cancer between May 2001 and December 2014 were invited to participate. Using the International Index of Erectile Function (IIEF) score the derived dichotomized erectile dysfunction (ED) was defined as moderate/severe or no/mild. Patients were grouped based on type of surgery [colon resection, rectal resection (RR) or local resection] and stratified for stoma, preoperative radiotherapy (RT), age and American Society of Anesthesiologists (ASA) score. RESULTS Of 10 037 eligible patients, 4334 responded (43.18%). The EF score was significantly lower for RR (mean 12.14) compared with both colon resection (mean 15.82) and local resection (mean 14.81) (p < 0.0001). No significant difference between colon resection and local resection was found (p = 0.29). Both a stoma and the use of RT were independent risk factors for ED. After excluding patients with stoma and RT and adjusting for age and ASA score, RR still had a higher risk of ED (OR 1.42, CI 1.20-1.67) compared with colon resection. CONCLUSION RR has a negative affect on EF. No difference between patients who underwent colon resection and local resection was found. RT and stoma were independent risk factors for ED.
Collapse
Affiliation(s)
| | | | - Hossam Elfeki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Katrine J Emmertsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| |
Collapse
|
16
|
Grass JK, Persiani R, Tirelli F, Chen CC, Caricato M, Pecorino A, Lang IJ, Kemper M, Izbicki JR, Melling N, Perez D. Robotic versus transanal total mesorectal excision in sexual, anorectal, and urinary function: a multicenter, prospective, observational study. Int J Colorectal Dis 2021; 36:2749-61. [PMID: 34537862 DOI: 10.1007/s00384-021-04030-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
17
|
Nishikawa Y, Horimatsu T, Nishizaki D, Kohno A, Yokoyama A, Yoshioka M, Hida K, Sakanaka K, Minamiguchi S, Seno H, Sakai Y, Nakayama T. Qualitative and Quantitative Analysis of Posttreatment Strategy After Endoscopic Resection for Patients with T1 Colorectal Cancer at High Risk of Lymph Node Metastasis. J Gastrointest Cancer 2020; 51:242-9. [PMID: 31044357 DOI: 10.1007/s12029-019-00247-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although endoscopic resection is increasingly performed to treat submucosal invasive colorectal cancer (T1CRC), approximately 10% are at risk of lymph node metastasis. The Japanese Society for Cancer of the Colon and Rectum guideline indicates that the following risk factors should be considered when deciding whether to perform additional surgical resection with lymph node dissection: depth of T1 invasion, lymphovascular invasion, poor histological grade, and budding grade 2/3. However, there is little information about the prognosis of T1CRC patients, or factors to consider when deciding subsequent treatment of high-risk T1CRC. METHODS This retrospective mixed method study was conducted using electronic medical records at Kyoto University Hospital between February 2005 and February 2015. Participants were T1CRC patients at risk of lymph node metastasis with at least one of the above four risk factors. They were assigned either careful follow-up (FU) or additional surgery (AS) through shared decision-making. To identify factors affecting decision-making in the FU group, we performed qualitative content analysis of electronic medical records. The prognosis of the groups was compared using the Kaplan-Meier method and the log-rank test. RESULTS Of 161 T1CRC patients, 18 were included in the FU group and 19 in the AS group. The median follow-up time was 39.5 (range 23-126) months for the FU group and 62 (range 22-141) months for the AS group. Factors considered in selecting FU were advanced age, comorbidities, the sole presence of the "depth" risk factor, and lower rectal cancer. For AS, the risk factors cited in the guideline were considered. There was one recurrent case in each group during the research period. There were no significant differences in overall survival, cause-specific survival, or recurrence-free survival between the groups. CONCLUSIONS Age, comorbidities, and lower-rectal cancer location were considered in deciding posttreatment strategy among high-risk T1CRC patients, alongside with positive vertical margin, depth, lymphovascular invasion, poor histologic grade, and budding. During the research period, there was no prognostic difference between the FU and AS groups.
Collapse
|
18
|
Nishizaki D, Hoshino N, Hida K, Nishikawa Y, Horimatsu T, Minamiguchi S, Sakanaka K, Sakai Y. Nonsurgical Management Following Local Resection for Early Rectal Cancer in Patients with High-risk Factors: A Single-institute Experience. J Anus Rectum Colon 2020; 4:174-180. [PMID: 33134598 PMCID: PMC7595679 DOI: 10.23922/jarc.2020-019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
Objective Additional surgery is considered for patients at high risk for lymph node metastasis (LNM) after local resection for early rectal cancer. Several factors are considered as indications for additional surgery, although there are currently no definitive criteria. This study aimed to clarify the need for additional surgery based on the number of risk factors for LNM and to evaluate the significance of submucosal invasion on recurrence. Methods Patients with early rectal cancer harboring risk factors for LNM who underwent local resection between March 2005 and December 2016 were retrospectively analyzed. Associations among the number of risk factors, prognosis, and additional treatment after local resection were investigated. Results A total of 29 eligible patients were classified into the surgery (n = 10), chemoradiotherapy (n = 7), and no-additional-treatment (NAT, n = 12) groups. Among the 29 patients, 15 patients (52%) with only one risk factor did not relapse. The NAT group harbored fewer risk factors for LNM, and 8 of the 12 patients (67%) had only deep submucosal invasion. Local recurrence occurred in one patient in the chemoradiotherapy group. The estimated 5-year overall survival rates were 88.9%, 75.0%, and 81.5% in the surgery, chemoradiotherapy, and NAT groups, respectively. There were no disease-specific deaths in the overall cohort. Conclusions In the present study, no recurrence occurred in patients who did not receive additional surgery with deep submucosal invasion as the only risk factor. A multicenter investigation is necessary to confirm the safety of nonsurgical options.
Collapse
Affiliation(s)
- Daisuke Nishizaki
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan.,Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Horimatsu
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Katsuyuki Sakanaka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
19
|
Pascual-Russo A, Milito D, Facio L, Furia M, Forestier V, Iseas S, Méndez G, Coraglio M, Lumi CM, Masciangioli G, Mauriño E, Vázquez H. Better quality of life and reduced fecal incontinence in rectal cancer patients with the watch-and-wait follow-up strategy. Rev Gastroenterol Mex (Engl Ed) 2020; 86:S0375-0906(20)30090-2. [PMID: 32868135 DOI: 10.1016/j.rgmx.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The watch-and-wait (WW) strategy is an alternative to anterior resection in patients with rectal cancer (RC) that have had a complete clinical response to neoadjuvant treatment. Few reports describe the quality of life and functional anorectal disorders (FADs) in that population. AIM To analyze and compare the FADs and quality of life in patients with locally advanced adenocarcinoma of the rectum treated with neoadjuvant therapy, divided into two different strategy groups: group 1 (G1), WW; and group 2 (G2), anterior resection. MATERIALS AND METHODS Thirty patients (G1: n = 20 and G2: n = 10) that had finished neoadjuvant therapy at least 12 months prior were included. Mean patient age was 59.5 years (range: 41-79) and 15 of the patients were men. The FADs were evaluated through: a) clinical history, b) 21-day bowel diary, c) Jorge and Wexner fecal incontinence scale, d) anorectal manometry (ARM), and fecal incontinence quality of life scale (FIQL). RESULTS Bowel diary: fecal incontinence (40%) and urge to defecate (45%) in G1 vs. fecal incontinence (60%) and urge to defecate (30%) in G2, with no significant differences (p = NS). Fecal incontinence scale: fecal incontinence in G1 was significantly less severe than that in G2 (median 6.5 points vs. 13 points [p = 0.0142]). ARM: no differences between the two groups. Quality of life: significantly different between the two groups (FIQL/G1: 3.7 vs. FIQL/G2: 2.8; p < 0.03). CONCLUSIONS The WW follow-up strategy in patients with locally advanced rectal cancer was associated with better quality of life and reduced fecal incontinence.
Collapse
Affiliation(s)
- A Pascual-Russo
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina.
| | - D Milito
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - L Facio
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Furia
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - V Forestier
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - S Iseas
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Méndez
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Coraglio
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - C M Lumi
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Masciangioli
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - E Mauriño
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - H Vázquez
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina; Investigador Asociado, Gobierno de la Ciudad de Buenos Aires. CABA, Argentina
| |
Collapse
|
20
|
Karlsson L, Bock D, Asplund D, Ohlsson B, Rosenberg J, Angenete E. Urinary dysfunction in patients with rectal cancer: a prospective cohort study. Colorectal Dis 2020; 22:18-28. [PMID: 31334903 PMCID: PMC6973078 DOI: 10.1111/codi.14784] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
Abstract
AIM Urinary dysfunction is one of many complications after treatment for rectal cancer. The aim of this study was to evaluate the prevalence of patient-reported urinary dysfunction at the time of diagnosis and at 1-year follow-up and to assess the risk factors linked to urinary incontinence. METHOD Patients with newly diagnosed rectal cancer were included in the QoLiRECT study between 2012 and 2015. Questionnaires from the time of diagnosis and 1-year follow-up were analysed, with 1085 and 916 patients, respectively, eligible for analysis. Regression analyses were made to investigate possible risk factors for incontinence. The patient cohort was also compared with a cohort from the Swedish general population. RESULTS At baseline, the prevalence of urinary dysfunction (14% of women, 8% of men) was similar to that in the general population. At 1-year follow-up, 20% of patients experienced urinary incontinence (29% of women, 14% of men). Emptying difficulties were experienced by 46% (41% of women, 49% of men) and urgency by 58% across both sexes. Abdominoperineal excision and urinary dysfunction at baseline were found to be independent risk factors for incontinence at 1-year follow-up. Among patients who were continent at baseline, risk factors were female sex, physical inactivity at baseline, comorbidity and abdominoperineal excision. CONCLUSION Urinary dysfunction is frequent among patients with rectal cancer, with up to a two-fold increase in symptoms 1 year after diagnosis. Unfortunately, few factors are modifiable and these results stress the importance of informing patients of possible outcomes related to urinary dysfunction after treatment for rectal cancer.
Collapse
Affiliation(s)
- L. Karlsson
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - D. Bock
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - D. Asplund
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden,Region Västra GötalandSahlgrenska University Hospital/ÖstraDepartment of SurgeryGothenburgSweden
| | - B. Ohlsson
- Department of SurgeryBlekinge HospitalKarlshamnSweden
| | - J. Rosenberg
- Department of SurgeryHerlev HospitalUniversity of CopenhagenHerlevDenmark
| | - E. Angenete
- Department of SurgeryInstitute of Clinical SciencesSSORG – Scandinavian Surgical Outcomes Research GroupSahlgrenska Academy at University of GothenburgGothenburgSweden,Region Västra GötalandSahlgrenska University Hospital/ÖstraDepartment of SurgeryGothenburgSweden
| |
Collapse
|
21
|
Marinello FG, Curell A, Tapiolas I, Pellino G, Vallribera F, Espin E. Systematic review of functional outcomes and quality of life after transanal endoscopic microsurgery and transanal minimally invasive surgery: a word of caution. Int J Colorectal Dis 2020; 35:51-67. [PMID: 31761962 DOI: 10.1007/s00384-019-03439-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The introduction of transanal endoscopic or minimally invasive surgery has allowed organ preservation for rectal tumors with good oncological results. Data on functional and quality-of-life (QoL) outcomes are scarce and controversial. This systematic review sought to synthesize fecal continence, QoL, and manometric outcomes after transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS). METHODS A systematic review of the literature including Medline, Embase, and the Cochrane Library databases was conducted searching for articles reporting on functional outcomes after TEM or TAMIS between January 1995 and June 2018. The evaluated outcome parameters were pre- and postoperative fecal continence (primary endpoint), QoL, and manometric results. Data were extracted using the same scales and measurement units as from the original study. RESULTS A total of 29 studies comprising 1297 patients were included. Fecal continence outcomes were evaluated in 23 (79%) studies with a wide variety of assessment tools and divergent results. Ten studies (34%) analyzed QoL changes, and manometric variables were assessed in 15 studies (51%). Most studies reported some deterioration in manometric scores without major QoL impairment. Due to the heterogeneity of the data, it was not possible to perform any pooled analysis or meta-analysis. CONCLUSIONS These techniques do not seem to affect continence by themselves except in minor cases. The possibility of worsened function after TEM and TAMIS should not be underestimated. There is a need to homogenize or standardize functional and manometric outcomes assessment after TEM or TAMIS.
Collapse
Affiliation(s)
- Franco G Marinello
- Colorectal Unit - Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Anna Curell
- Colorectal Unit - Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Tapiolas
- Colorectal Unit - Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gianluca Pellino
- Colorectal Unit - Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesc Vallribera
- Colorectal Unit - Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eloy Espin
- Colorectal Unit - Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
22
|
Hamamoto H, Yamamoto M, Masubuchi S, Ishii M, Osumi W, Tanaka K, Okuda J, Uchiyama K. Male sex and anterior wall tumor location as risk factors for urinary dysfunction after laparoscopic rectal surgery. Surg Endosc 2019; 34:3567-3573. [DOI: 10.1007/s00464-019-07186-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 10/01/2019] [Indexed: 01/13/2023]
|
23
|
|
24
|
Sposato LA, Lam Y, Karapetis C, Vatandoust S, Roy A, Hakendorf P, Dwyer A, de Fontgalland D, Hollington P, Wattchow D. Observation of "complete clinical response" in rectal cancer after neoadjuvant chemoradiation: The Flinders experience. Asia Pac J Clin Oncol 2018; 14:439-445. [PMID: 29932278 DOI: 10.1111/ajco.12993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 04/29/2018] [Indexed: 01/17/2023]
Abstract
AIM Observation with close follow-up ("watch and wait") is a recognized treatment option in patients who achieve a complete clinical response to long course chemoradiotherapy. This review of a prospective database aims to evaluate the clinical outcomes among patients with a complete clinical response managed with observation. METHODS A prospective study of 32 patients who achieved a complete clinical response was undertaken. The primary outcomes measured were overall and recurrence-free survival, and rate of organ preservation in patients who deferred immediate surgery. RESULTS Seven patients developed local regrowth over a median follow-up period of 38 months (range, 9-91 months). Median time to detection was 12 months. All seven underwent salvage surgery with complete surgical clearance. One patient developed combined local and systemic recurrence following a low anterior resection. Organ preservation was possible in 25 (78%) patients who sustained a complete clinical response with no evidence of local regrowth or disease recurrence. Among the patients who sustained a complete response, two developed isolated systemic disease. Overall and recurrence-free survival was 95.7% and 87.0%, respectively. CONCLUSION The majority of patients with rectal cancer who achieved a complete clinical response after chemoradiotherapy and managed with a "watch and wait" approach preserved their rectum and did not develop cancer relapse. Salvage surgery was achieved in all patients who developed local regrowth. The study supports a period of observation in rectal cancer patients who achieve a complete clinical response.
Collapse
Affiliation(s)
- Luigi A Sposato
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Yick Lam
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Chris Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Sina Vatandoust
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Amitesh Roy
- Department of Medical Oncology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Paul Hakendorf
- Department of Epidemiology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Dwyer
- Department of Radiology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Dayan de Fontgalland
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - Paul Hollington
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| | - David Wattchow
- Department of Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia
| |
Collapse
|
25
|
Kim HJ, Choi GS, Park JS, Park SY, Yang CS, Lee HJ. The impact of robotic surgery on quality of life, urinary and sexual function following total mesorectal excision for rectal cancer: a propensity score-matched analysis with laparoscopic surgery. Colorectal Dis 2018; 20:O103-O113. [PMID: 29460997 DOI: 10.1111/codi.14051] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/11/2017] [Indexed: 02/08/2023]
Abstract
AIM Quality of life (QoL) and functional outcomes are at risk of being impaired after rectal surgery, but there has been no large prospective study to thoroughly assess QoL according to surgical approach. We have investigated the impact of laparoscopic and robotic total mesorectal excision (TME) on QoL and functional outcomes. METHOD Patients undergoing laparoscopic or robotic TME for rectal cancer between 2009 and 2013 were prospectively included in this questionnaire-based survey of QoL together with variations in urinary and sexual function. A propensity score analysis was retrospectively conducted to compare outcomes between groups in a cohort matched 1:1 for age, sex, body mass index, preoperative chemoradiation status and tumour height. The survey was performed preoperatively and 3, 6 and 12 months after surgery. RESULTS Global health status/QoL was similar between the two groups for 130 matched pairs, but the robotic group showed better role, emotional and social functioning and experienced less fatigue and financial difficulty. International Prostatic Symptom Scores in men increased postoperatively, with significantly less impairment in the robotic group at 6 months. These scores were comparable to preoperative scores at 6 months in the robotic group and at 12 months in the laparoscopic group. Of 48 sexually active men in each group, International Index of Erectile Function-5 scores decreased postoperatively, returning to preoperative levels at 6 months in the robotic group and at 12 months in the laparoscopic groups. CONCLUSION The robotic approach for TME was associated with less impairment of urinary and sexual function; QoL was comparable to the laparoscopic approach.
Collapse
Affiliation(s)
- H J Kim
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - G-S Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - J S Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - S Y Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - C S Yang
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - H J Lee
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
26
|
Serra-Aracil X, Gràcia R, Mora-López L, Serra-Pla S, Pallisera-Lloveras A, Labró M, Navarro-Soto S. How to deal with rectal lesions more than 15 cm from the anal verge through transanal endoscopic microsurgery. Am J Surg 2018; 217:53-58. [PMID: 29709273 DOI: 10.1016/j.amjsurg.2018.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study is to assess postoperative morbidity and mortality in tumors with a proximal margin 15 cm or more from the anal verge operated with transanal endoscopic microsurgery (TEM). METHODS This observational study of consecutive rectal tumor patients undergoing TEM was carried out from July 2004 to June 2017. We compared the results of rectal tumors at distances of ≥15 cm (group A) and <15 cm (group B) from the anal verge. RESULTS During the study period 667 patients were included: 118 in group A and 549 in group B. In the comparative analysis there were no significant differences in morbidity (p = 0.23), mortality (p = 0.32) or free margin involvement (p = 0.545). Differences were observed in terms of lesion size (p < 0.001), surgical time (p < 0.001) and peritoneal cavity perforation, which were all increased in group A. CONCLUSION TEM for lesions in the rectosigmoid junction is feasible and is not associated with higher morbidity or mortality.
Collapse
Affiliation(s)
- Xavier Serra-Aracil
- Coloproctology Unit. General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell (Barcelona), Spain.
| | - Raquel Gràcia
- Coloproctology Unit. General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell (Barcelona), Spain
| | - Laura Mora-López
- Coloproctology Unit. General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell (Barcelona), Spain
| | - Sheila Serra-Pla
- Coloproctology Unit. General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell (Barcelona), Spain
| | - Anna Pallisera-Lloveras
- Coloproctology Unit. General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell (Barcelona), Spain
| | - Maritxell Labró
- Coloproctology Unit. General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell (Barcelona), Spain
| | - Salvador Navarro-Soto
- Coloproctology Unit. General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell (Barcelona), Spain
| |
Collapse
|
27
|
George D, Pramil K, Kamalesh NP, Ponnambatheyil S, Kurumboor P. Sexual and urinary dysfunction following laparoscopic total mesorectal excision in male patients: A prospective study. J Minim Access Surg 2018; 14:111-117. [PMID: 28928335 PMCID: PMC5869969 DOI: 10.4103/jmas.jmas_93_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims: Even with the use of nerve-sparing techniques, there is a risk of bladder and sexual dysfunction after total mesorectal excision (TME). Laparoscopic TME is believed to improve this autonomic nerve dysfunction, but this is not demonstrated conclusively in the literature. In Indian patients generally, the stage at which the patients present is late and presumably the risk of autonomic nerve injury is more; however, there is no published data in this respect. Materials and Methods: This prospective study in male patients who underwent laparoscopic TME evaluated the bladder and sexual dysfunction using objective standardised scores, measuring residual urine and post-voided volume. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function score were used respectively to assess the bladder and sexual dysfunction preoperatively at 1, 3, 6 months and at 1 year. Results: Mean age of the study group was 58 years. After laparoscopic TME in male patients, the moderate to severe bladder dysfunction (IPSS <8) is observed in 20.4% of patients at 3 months, and at mean follow-up of 9.2 months, it was seen only in 2.9%. There is more bladder and sexual dysfunction in low rectal tumours compared to mid-rectal tumours. At 3 months, 75% had sexual dysfunction, 55% at median follow-up of the group at 9.2 months. Conclusion: After laparoscopic TME, bladder dysfunction is seen in one-fifth of the patients, which recovers in the next 6 months to 1 year. Sexual dysfunction is observed in 75% of patients immediately after TME which improves to 55% over 9.2 months.
Collapse
Affiliation(s)
- Deepak George
- Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India
| | - Kaniyarakkal Pramil
- Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India
| | | | - Shaji Ponnambatheyil
- Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India
| | - Prakash Kurumboor
- Department of Gastrointestinal Surgery, PVS Memorial Hospital, Cochin, Kerala, India
| |
Collapse
|
28
|
Abstract
During the last 15 years, a significant evolution has emerged in the surgical treatment of rectal cancer and restoration of bowel continuity has been one of the main goals. For many years the treatment of distal rectal cancer would necessarily require an abdominoperineal resection and end colostomy. The surgical procedure of intersphincteric resection has been proposed to offer sphincter preservation in patients with low rectal cancer and has been legitimized if executed according to adequate oncologic criteria. This article will discuss the best indications, technical aspects, functional, and oncological outcomes of intersphicteric resection in the management of rectal cancer.
Collapse
Affiliation(s)
- Quentin Denost
- Colorectal Unit, Department of Surgery, Centre Magellan, Haut Lévèque University Hospital, Bordeaux/Pessac, France
| | - Eric Rullier
- Colorectal Unit, Department of Surgery, Centre Magellan, Haut Lévèque University Hospital, Bordeaux/Pessac, France
| |
Collapse
|
29
|
Abstract
INTRODUCTION Sexual and urological problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. The urogenital function is dependent on dual autonomic sympathetic and parasympathetic innervation, and four key danger zones exist that are at risk for nerve damage during colorectal surgery: one of these sites is in the abdomen and three are in the pelvis. The aim of this study is to systematically review the epidemiology of sexual dysfunction following rectal cancer surgery, to describe the anatomical basis of autonomic nerve-preserving techniques, and to explore the scientific evidence available to support the laparoscopic or robotic approach over open surgery. METHODS According to the PRISMA guidelines, a comprehensive literature search of studies evaluating sexual function in patients undergoing rectal surgery for cancer was performed in Medline, Scopus, Web of Science, Embase, and Cochrane Central Register of controlled trials. RESULTS An increasing number of studies assessing the incidence and prevalence of sexual dysfunction following multimodality treatment for rectal cancer has been published over the last 30 years. Significant heterogeneity in the prevalence of sexual dysfunction is reported in the literature, with rates between 5 and 90%. CONCLUSIONS There is no evidence to date in favor of any surgical approach (open vs laparoscopic vs robotic). Standardized diagnostic tools should be routinely used to prospectively assess sexual function in patients undergoing rectal surgery.
Collapse
Affiliation(s)
- V Celentano
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Rd, Portsmouth, PO6 3LY, UK.
| | - R Cohen
- Department of Colorectal Surgery, University College London Hospitals, 235 Euston Rd, Bloomsbury, London, NW1 2BU, UK
| | | | - O Faiz
- Department of Surgery, St. Mark's Hospital, Harrow, UK
| | - M Chand
- Department of Colorectal Surgery, University College London Hospitals, 235 Euston Rd, Bloomsbury, London, NW1 2BU, UK
| |
Collapse
|
30
|
Attaallah W, Ertekin SC, Yegen C. Prospective study of sexual dysfunction after proctectomy for rectal cancer. Asian J Surg 2017; 41:454-461. [PMID: 28800864 DOI: 10.1016/j.asjsur.2017.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/04/2017] [Accepted: 04/18/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although rectal cancer is a common malignancy and has an improved cure rate in response to oncological treatment, research on rectal-cancer survivors' sexual function remains limited. OBJECTIVE The aim of this prospective study is to assess sexual dysfunction after rectal cancer surgery. PATIENTS AND METHODS Patients undergoing curative rectal cancer surgery were included in the study. Sexual function before and 6 months after the operation was measured using the validated questionnaires. Primary outcome was to determine the rates of Sexual dysfunction after rectal cancer surgery. Furthermore, the factors which can have an impact on sexual function after radical treatment have been assessed. RESULTS A total of 187 patients [117 (63%) men and 70 (37%) women] with rectal cancer who underwent radical resection were included in the study. Sexual function has significantly decreased after surgery. Among male patients, sexual dysfunction increased from the baseline 4% (n = 5) up to 41% (n = 48) after the operation. Among female patients, sexual dysfunction increased from the baseline 53% (n = 37) up to 77% (n = 54) after the operation. A significant lower rate of laparoscopic surgery has been found in both males and females who reported sexual dysfunction after surgery. The patients who have locally advanced disease and those who received postoperative chemotherapy or radiotherapy have higher rates of sexual dysfunction. CONCLUSION This study, showed that sexual dysfunction is common in patients with rectal cancer after radical treatment. However, patients who underwent laparoscopic surgery have lower rates of sexual dysfunction than those who underwent open surgery.
Collapse
Affiliation(s)
- Wafi Attaallah
- Marmara University School of Medicine, Department of General Surgery, Istanbul, Turkey.
| | | | - Cumhur Yegen
- Marmara University School of Medicine, Department of General Surgery, Istanbul, Turkey
| |
Collapse
|
31
|
Patrick Selph J, Saidian A. The Pharmacologic Management of Voiding Dysfunction, Stress Incontinence and the Overactive Bladder in Men and Women Who Have Had Prior Treatment for Pelvic Malignancies With Surgery or Radiation Therapy. Curr Bladder Dysfunct Rep 2017. [DOI: 10.1007/s11884-017-0417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
32
|
Abstract
Literature on postoperative urinary retention (POUR) after colorectal resections is limited. The aim of our study was to evaluate the incidence of and risk factors for POUR after elective colorectal resections in men ≥55 years without genitourinary issues. A retrospective review of elective colorectal resections (June 1, 2014 to June 1, 2015) in men ≥55 years without genitourinary conditions was performed at our institution. Patient demographics, American Society of Anesthesiologist score, body mass index (BMI), surgical history, type of disease, extent of resection, surgical approach, operating room (OR) time, volume of OR fluids administered, and intra- and postoperative urine output were included for analysis. Seventy patients were identified. Nine (12.9%) experienced POUR. Patients with POUR experienced longer OR time (324 vs 239 minutes; P = 0.048) and had a lower median BMI (23.8 vs 28 kg/m2; P = 0.038). There were no significant differences in regards to age, comorbidities, diagnosis, type of resection, surgical approach, intravenous fluids administered operatively, or postoperative urine output. The incidence of POUR in male patients at least 55 years of age after elective colorectal resection in our institution was 12.9 per cent. Longer operative time and lower BMI were associated with a higher incidence of POUR.
Collapse
Affiliation(s)
- Ethan J. Hoppe
- Division of General Surgery, TriHealth, Cincinnati, Ohio
| | | | - Scott R. Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota; and the
| | - Lala R. Hussain
- TriHealth Hatton Research Institute, TriHealth, Cincinnati, Ohio
| | | | - Alex K. Saba
- Division of General Surgery, TriHealth, Cincinnati, Ohio
| |
Collapse
|
33
|
Phan YC, Sebastian J, Harilingam M, Tsavellas G. Survey on consenting practice and discussion of post-operative erectile dysfunction following rectal cancer surgery. Journal of Clinical Urology 2017. [DOI: 10.1177/2051415816668944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Sexual dysfunction is a recognized complication of rectal cancer surgery, due to the close proximity of the pelvic autonomic nerves to the normal plane of dissection. The consenting process should therefore always include the risk of sexual and urinary dysfunction arising after such surgery. This survey was undertaken to assess the consenting practice, and to evaluate the frequency of use of phosphodiesterase Type 5 (PDE5) inhibitors to treat erectile dysfunction (ED) following rectal cancer surgery. Methods: All listed Association of Coloproctology of Great Britain and Ireland (ACPGBI) members were invited to participate in the electronic survey, which comprised six questions. By 8 weeks, 119 responses had been received. Results: There were 112 respondents (94.1%) who routinely discussed the risk of ED during the process of gaining consent for rectal cancer surgery. There were 104 respondents (87.3%) who documented ED on their consent form. There were 24 respondents (20.2%) who indicated that there was no stated percentage risk for ED; and there were 69 (58.0%) and 26 (21.9%) respondents who quoted there was a 0–25% and 26–50% risk of ED during the consent process, respectively. None were quoting > 50% risk of ED. There were 68 respondents (57.1%) who routinely enquired about ED during follow-up. There were 30 respondents (25.2%) who stated that they had experience in prescribing PDE5 inhibitors for their patients who suffer from ED: We had 25 of them who felt that patients benefited from using PDE5 inhibitors. Conclusions: The majority of colorectal surgeons routinely discuss and document the risk of ED when consenting for rectal surgery; however, most surgeons have no experience in prescribing PDE5 inhibitors. This is an area that requires further study and education.
Collapse
Affiliation(s)
- Yih Chyn Phan
- Department of General Surgery, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Joseph Sebastian
- Department of General Surgery, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Mohan Harilingam
- Department of General Surgery, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - George Tsavellas
- Department of General Surgery, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| |
Collapse
|
34
|
Adam JP, Denost Q, Capdepont M, van Geluwe B, Rullier E. Prospective and Longitudinal Study of Urogenital Dysfunction After Proctectomy for Rectal Cancer. Dis Colon Rectum 2016; 59:822-30. [PMID: 27505110 DOI: 10.1097/DCR.0000000000000652] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urogenital dysfunctions after rectal cancer treatment are well recognized, although incidence and evolution over time are less well known. OBJECTIVE We aimed to assess the evolution of urogenital functions over time after the treatment for rectal cancer. DESIGN This is a prospective, longitudinal cohort study. SETTINGS This study was conducted at a quaternary referral center for colorectal surgery. PATIENTS A total of 250 consecutive patients treated for rectal cancer were prospectively enrolled for urogenital assessment. MAIN OUTCOME MEASURES End points were the International Prostatic Symptom Score, the International Index of Erectile Function, and the Female Sexual Index obtained by questionnaires before (baseline status) and after preoperative radiotherapy and 3, 6, and 12 months after surgery. RESULTS Overall, 169 patients (68%) responded to the questionnaires. The urinary function decreased temporary after irradiation in men (International Prostatic Symptom Score: 7.8 vs 4.9; p < 0.001). Sexual activity decreased significantly in women after radiotherapy (p = 0.02), and in all patients after surgery (p < 0.001). At 12 months, sexual activity in women declined from 59% before treatment to 36% (p = 0.02). In men, sexual activity (82% vs 57%), erectile function (71% vs 24%), and ejaculatory function (78% vs 32%) decreased from baseline (p < 0.001). Stage T3T4 tumors (OR = 5.72 (95% CI, 1.24-26.36)) and low rectal tumors (OR = 17.86 (95% CI, 1.58-20.00)) were independent factors of worse sexual function. LIMITATIONS This study was limited by the proportion of uncompleted questionnaires, especially in women, and by its monocentric feature. CONCLUSIONS Most patients experienced sexual dysfunction at 12 months after surgery for rectal cancer, and predictive factors for this dysfunction were related to characteristics of the tumor.
Collapse
|
35
|
Chew MH, Yeh YT, Lim E, Seow-Choen F. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf) 2016; 4:173-85. [PMID: 27478196 PMCID: PMC4976685 DOI: 10.1093/gastro/gow023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023] Open
Abstract
The advent of total mesorectal excision (TME) together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results. However, the incidence of bladder and sexual dysfunction remains high. This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur. The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes. In this review, we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle, the lateral pelvic wall and dissection around the urogenital organs. Surgical techniques in these areas are discussed. We also discuss the results in functional outcomes of the various techniques including open, laparoscopic and robotic over the last 30 years.
Collapse
Affiliation(s)
- Min-Hoe Chew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Yu-Ting Yeh
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Evan Lim
- Singhealth Academy, Singapore General Hospital, Singapore
| | | |
Collapse
|
36
|
Saito S, Fujita S, Mizusawa J, Kanemitsu Y, Saito N, Kinugasa Y, Akazai Y, Ota M, Ohue M, Komori K, Shiozawa M, Yamaguchi T, Akasu T, Moriya Y. Male sexual dysfunction after rectal cancer surgery: Results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 2016; 42:1851-1858. [PMID: 27519616 DOI: 10.1016/j.ejso.2016.07.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/24/2016] [Accepted: 07/14/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We conducted a randomized controlled trial (JCOG0212) to determine whether the outcome of mesorectal excision (ME) alone for rectal cancer is not inferior to that of ME with lateral lymph node dissection (LLND). The present study focused on male sexual dysfunction after surgery. METHODOLOGY Eligibility criteria included clinical stage II/III rectal cancer, the lower margin of the lesion below the peritoneal reflection, the absence of lateral pelvic lymph node enlargement, and no preoperative radiotherapy. After confirmation of R0 resection by ME, patients were intraoperatively randomized. Questionnaires using the International Index of Erectile Function (IIEF-5) about the sexual function of men were collected before and 1 year after surgery. Sexual dysfunction incidence was defined as the ratio of patients showing sexual dysfunction after surgery relative to the number who had no erectile dysfunction before surgery. RESULTS Among 701 patients enrolled between June 2003 and August 2010, 472 males were included. Among them, 343 (73%) completed preoperative and postoperative questionnaires. According to the study protocol, the incidences of sexual dysfunction in patients who underwent ME alone and ME with LLND were 68% (17/25; 95%CI, 47-85%) and 79% (23/29; 95%CI, 60-92%), respectively (p = 0.37). Incidences of sexual dysfunction in patients with no or only mild erectile dysfunction before surgery who underwent ME alone and ME with LLND were 59% (48/81) and 71% (67/95), respectively (p = 0.15). Multivariate analysis identified age as the only risk factor for sexual dysfunction after surgery (p = 0.02). CONCLUSIONS LLND may not increase sexual dysfunction incidence after rectal cancer surgery. This incidence is associated with increased age. This trial is registered with ClinicalTrials.gov, number NCT00190541 and University Hospital Medical Information Network Clinical Trials Registry, number C000000034.
Collapse
Affiliation(s)
- S Saito
- Division of Surgery, Gastrointestinal Center, Yokohama Shin-Midori General Hospital, 1726-7, Tokaichiba-cho, Midori-ku, Yokohama 226-0025, Japan.
| | - S Fujita
- Department of Surgery, Tochigi Cancer Center, 4-9-13, Yonan, Utsunomiya 320-0834, Japan.
| | - J Mizusawa
- JCOG Data Center, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Y Kanemitsu
- Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - N Saito
- Department of Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
| | - Y Kinugasa
- Department of Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
| | - Y Akazai
- Department of Surgery, Okayama Saiseikai General Hospital, 1-17-18, Ifuku-cho, Kita-ku, Okayama 700-8511, Japan.
| | - M Ota
- Department of Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
| | - M Ohue
- Department of Surgery, Osaka Medical Center and Cardiovascular Diseases, 1-3-3, Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
| | - K Komori
- Department of Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
| | - M Shiozawa
- Department of Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama 241-8515, Japan.
| | - T Yamaguchi
- Department of Surgery, National Hospital Organization Kyoto Medical Center, 1-1, Kusafukamukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan.
| | - T Akasu
- The Imperial Household Agency Hospital, 1-2, Chiyoda, Chiyoda-ku, Tokyo 100-0001, Japan.
| | - Y Moriya
- Department of Surgery, Miki Hospital, 100 Ushizawauwano, Kojo, Maesawa-ku, Oushu, Iwate 029-4201, Japan.
| | | |
Collapse
|
37
|
Dulskas A, Samalavicius NE. A prospective study of sexual and urinary function before and after total mesorectal excision. Int J Colorectal Dis 2016; 31:1125-30. [PMID: 26960814 DOI: 10.1007/s00384-016-2549-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncological treatment, research on rectal cancer survivors' urogenital function remains limited. In this study, urogenital dysfunction after surgical rectal cancer treatment was measured and possible predisposing factors that may have an impact on the development of this disorder were discussed. METHODS One hundred eight patients undergoing curative rectal cancer surgery from January 2008 to December 2014 were questioned using questionnaires: male urinary function was assessed using the International Prostatic Symptom Score (IPSS) questionnaire, for sexual function-International Index of Erectile Function (IIEF). The Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire and the Female Sexual Function Index (FSFI) were used for female urogenital function assessment prior to the operation and 6 months postoperatively. RESULTS A total of 67.0 % of male (36) and 33.0 % (18) of female patients who completed the questionnaire were included in the study. Preoperatively, male urinary dysfunction was 80.1 % and postoperatively-88.9 %. In female patients, preoperative urinary dysfunction was seen in 75.0 % patients, postoperatively-78.0 %. Erectile dysfunction was seen in 41.7 % males preoperatively and in 63.9 % postoperatively. A total of 83.3 % of female patients had sexual dysfunction preoperatively and 94 % postoperatively. CONCLUSION Sexual and urinary problems after surgery for rectal cancer are common. Preoperative genitourinary dysfunction is not uncommon in patients older than 60 years as well. Female patients reported higher rates of sexual dysfunction than males. These results point out the importance of sexual and urinary (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.
Collapse
|
38
|
Shieh SI, Lin YH, Huang CY, Kao CC, Hung SL, Yang HY, Tung HY. Sexual dysfunction in males following low anterior resection. J Clin Nurs 2016; 25:2348-56. [PMID: 27080210 DOI: 10.1111/jocn.13172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore the prevalence of sexual dysfunction in males one year after undergoing low anterior resection and to determine whether health care professionals discuss sexual issues with patients after surgery. BACKGROUND Sexual dysfunction in males may be a complication after low anterior resection for rectal cancer, but few studies have explored this issue in Taiwan. DESIGN A descriptive comparison study design. METHODS A descriptive comparison design was used, and a group of 133 participants underwent a low anterior resection procedure for rectal cancer. The results were compared with those of a group of males who underwent colectomy (n = 58) for colon cancer. The following instruments were used: the five-item version of the International Index of Erectile Function, personal demographics and medical variables. RESULTS The results showed that the prevalence of erectile dysfunction among the low anterior resection patients was 97·0% (129/133), and the erectile dysfunction prevalence was 75·9% (44/58) for the males who underwent colectomy. The generalised linear model showed that after controlling for hypertension and stoma, the low anterior resection group had worse sexual function than those in the colectomy group, and stoma was also a factor that impacted patients' sexual function. The results also revealed that only 32·8-35·3% of health care providers talked about sexual dysfunction with people who have rectal cancer prior to surgery. CONCLUSION This study demonstrated that men who have undergone low anterior resection have a high risk of sexual dysfunction and that health care professionals infrequently discuss these issues with patients. RELEVANCE TO CLINICAL PRACTICE When patients are diagnosed with rectal cancer and before they undergo surgery, an assessment and discussion of sexual function issues should be incorporated into standard care. Continued follow-up after hospital discharge and evaluations of sexual function are vital factors for male postoperative rectal cancer patients.
Collapse
Affiliation(s)
- Show-Ing Shieh
- College of Liberal Education, Shu-Te University, Kaohsiung, Taiwan
| | - Yu-Hua Lin
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | | | - Chia-Chan Kao
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Ling Hung
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Hsing-Yu Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Hong-Yu Tung
- Medical Education & Research Department, Yuan's General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
39
|
Abstract
Quality of life in general and sexual functioning in particular have become very important in cancer patients. Biological factors such as anatomic alterations, physiological changes and secondary effect of medical interventions may preclude normal sexual functioning even when sexual desire is intact. In spite of modern surgical techniques, improved chemotherapeutical drugs and sophisticated radiation techniques, still many patients complain of impaired sexual function after cancer treatment. A large number of instruments already exist to assess quality of life in cancer patients. It is important to standardize procedures and to use validated questionnaires. Collecting data on an ongoing basis before and long after treatment is mandatory, and control groups must be used. Patients should be offered sexual counselling and informed about the availability of therapies for sexual dysfunctions. In this paper we review the topic of sexual functioning after treatment (predominantly after radiotherapy) of the most common malignancies in men and give suggestions for treatment.
Collapse
Affiliation(s)
- Luca Incrocci
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer, Rotterdam, The Netherlands
| |
Collapse
|
40
|
Abstract
Azoospermia is a heterogeneous condition with multiple etiologies and a variety of treatments. In this chapter we present a summary of retrograde ejaculation and anejaculation, both of which are characterized by an absence of antegrade semen propulsion through the male reproductive tract. Each of these affects fertility, but is pathophysiologically distinct disorders with differing evaluation and treatment. Retrograde ejaculation has a myriad of well-characterized causes, from pharmacologic disruption to interference of neural mechanisms by surgical intervention for a variety of diseases. Medication is the mainstay of treatment, although only a minority responds and develops antegrade ejaculation. For the men who are not responders to medical therapy, but still have fertility goals, there are a variety of sperm retrieval techniques to assist their reproductive abilities. Failure of emission is characterized by an absence of the emission phase and no antegrade or retrograde expulsion of ejaculatory products. If fertility is desired, these men must rely on assisted ejaculatory procedures, and treatment choice is guided by etiology and response. Ultimately, retrograde ejaculation and failure of emission are in a spectrum of ejaculatory disorders which impair male fertility.
Collapse
Affiliation(s)
- Louis Revenig
- 1 Emory University, Department of Urology, Atlanta, Georgia, USA ; 2 Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
| | - Andrew Leung
- 1 Emory University, Department of Urology, Atlanta, Georgia, USA ; 2 Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
| | - Wayland Hsiao
- 1 Emory University, Department of Urology, Atlanta, Georgia, USA ; 2 Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
| |
Collapse
|
41
|
Wang G, Wang Z, Jiang Z, Liu J, Zhao J, Li J. Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer. Int J Med Robot 2016; 13. [PMID: 26748601 DOI: 10.1002/rcs.1725] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/10/2015] [Accepted: 12/01/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Urinary and sexual dysfunction is the potential complication of rectal cancer surgery. The aim of this study was to evaluate the urinary and sexual function in male patients with robotic surgery for rectal cancer. METHODS This prospective study included 137 of the 336 male patients who underwent surgery for rectal cancer. Urinary and male sexual function was studied by means of a questionnaire based on the International Prostatic Symptom Score and International Index of Erectile Function. All data were collected before surgery and 12 months after surgery. RESULTS Patients who underwent robotic surgery had significantly decreased incidence of partial or complete erectile dysfunction and sexual dysfunction than patients with laparoscopic surgery. The pre- and post-operative total IPSS scores in patients with robotic surgery were significantly less than that with laparoscopic surgeries. CONCLUSIONS Robotic surgery shows distinct advantages in protecting the pelvic autonomic nerves and relieving post-operative sexual dysfunction.
Collapse
Affiliation(s)
- Gang Wang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Jiangsu, People's Republic of China
| | - Zhiming Wang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Jiangsu, People's Republic of China
| | - Zhiwei Jiang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Jiangsu, People's Republic of China
| | - Jiang Liu
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Jiangsu, People's Republic of China
| | - Jian Zhao
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Jiangsu, People's Republic of China
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Jiangsu, People's Republic of China
| |
Collapse
|
42
|
Mora López L, Serra-Aracil X, Navarro Soto S. Sphincter lesions observed on ultrasound after transanal endoscopic surgery. World J Gastroenterol 2015; 21:13160-13165. [PMID: 26674666 PMCID: PMC4674735 DOI: 10.3748/wjg.v21.i46.13160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/29/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the morphological impact of transanal endoscopic surgery on the sphincter apparatus using the modified Starck classification.
METHODS: A prospective, observational study of 118 consecutive patients undergoing Transanal Endoscopic Operation/Transanal Endoscopic Microsurgery (TEO/TEM) from March 2013 to May 2014 was performed. All the patients underwent an endoanal ultrasound prior to surgery and one and four months postoperatively in order to measure sphincter width, identify sphincter defects and to quantify them in terms of the level, depth and size of the affected anal canal. To assess the lesions, we used the “modified” Starck classification, which incorporates the variable “sphincter fragmentation”. The results were correlated with the Wexner incontinence questionnaire.
RESULTS: Of the 118 patients, twelve (sphincter lesions) were excluded. The results of the 106 patients were as follows after one month: 31 (29.2%) lesions found on ultrasound after one month, median overall Starck score of 4 (range 3-6); 10 (9.4%) defects in the internal anal sphincter (IAS) and 3 (2.8%) in the external anal sphincter (EAS); 17 patients (16%) had fragmentation of the sphincter apparatus with both sphincters affected in one case. At four months: 7 (6.6%) defects, all in the IAS, overall median Starck score of 4 (range 3-6). Mean IAS widths were 3.5 mm (SD 1.14) preoperatively, 4.38 mm (SD 2.1) one month postoperatively and 4.03 mm (SD 1.46) four months postoperatively. The only statistically significant difference in sphincter width in the IAS measurements was between preoperatively and one month postoperatively. No incontinence was reported, even in cases of ultrasound abnormalities.
CONCLUSION: TEO/TEM may produce ultrasound abnormalities but this is not accompanied by clinical changes in continence. The modified Starck classification is useful for describing and managing these disorders.
Collapse
|
43
|
Kraima AC, West NP, Treanor D, Magee DR, Bleys RLAW, Rutten HJT, van de Velde CJH, Quirke P, DeRuiter MC. Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves. Eur J Surg Oncol 2015; 41:1621-9. [PMID: 26422586 DOI: 10.1016/j.ejso.2015.08.166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/07/2015] [Accepted: 08/17/2015] [Indexed: 12/13/2022] Open
Abstract
AIM Excellent understanding of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, fasciae anterolateral to the rectum and surrounding the low rectum are still poorly understood. We studied the perirectal fascia enfolding the extraperitoneally located part of the rectum in en-bloc cadaveric specimens and the University Medical Center Utrecht (UMCU) pelvic dataset, and describe implications for TME. METHODS Four donated human adult cadaveric specimens (two males, two females) were obtained through the Leeds GIFT Research Tissue Programme. Paraffin-embedded blocks were produced and serially sectioned at 50 and 250 μm intervals. Whole mount sections were stained with haematoxylin & eosin, Masson's trichrome and Millers' elastin. Additionally, the UMCU pelvic dataset including digitalised cryosections of a female pelvis in three axes was studied. RESULTS The mid and lower rectum were surrounded by a multi-layered perirectal fascia, of which the mesorectal fascia (MRF) and parietal fascia bordered the 'holy plane'. There was no extra constant fascia forming a potential surgical plane. Nerves ran laterally to the MRF. More caudally, the mesorectal fat strongly reduced and the MRF approached the rectal muscularis propria. The MRF had a variable appearance in terms of thickness and completeness, most prominently at the anterolateral lower rectum. CONCLUSION Dissection onto the MRF allows nerve preservation in TME. Rectal surgeons are challenged in doing so as the MRF varies in thickness and shows gaps, most prominently at the anterolateral lower rectum. At this site, the risk of entering the mesorectum is great and may result in an incomplete specimen.
Collapse
Affiliation(s)
- A C Kraima
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands; Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D Treanor
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D R Magee
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P Quirke
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - M C DeRuiter
- Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
44
|
Ozeki S, Maeda K, Hanai T, Masumori K, Katsuno H, Takahashi H. Effects of robotic rectal surgery on sexual and urinary functions in male patients. Surg Today. 2016;46:491-500. [PMID: 26198896 DOI: 10.1007/s00595-015-1217-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSES This study prospectively assessed the sexual and urinary functions, as well as factors influencing these functions, in patients who underwent open or robotic surgery for rectal cancer. METHODS Forty-five consecutive male patients who underwent rectal resection for rectal cancer were prospectively enrolled in this study. Their sexual and urinary functions were assessed through self-administered questionnaires comprising the International Index of Erectile Function (IIEF; sexual function) and the International Prostate Symptom Score (IPSS; urinary function) before and at 3, 6, and 12 months after surgery. RESULTS Fifteen patients who underwent robotic surgery and 22 who underwent open surgery were finally analyzed in this study. The total IIEF score and the individual score items did not change at 3, 6 or, 12 months after open or robotic surgery compared with the preoperative values. However, a univariate analysis revealed that age affected the urinary function 12 months after surgery, while both univariate and multivariate analyses revealed that postoperative complications affected the sexual function 12 months after surgery. CONCLUSIONS In this non-randomized comparison, the postoperative sexual and urinary functions were comparable between patients who underwent open rectal surgery and those who underwent robotic rectal surgery. Postoperative complications were a risk factor for sexual dysfunction, while age was a risk factor for urinary dysfunction.
Collapse
|
45
|
Bondeven P, Emmertsen KJ, Laurberg S, Pedersen BG. Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery. Eur J Surg Oncol 2015. [PMID: 26219852 DOI: 10.1016/j.ejso.2015.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The combination of advances in surgical technique and neoadjuvant therapy for rectal cancer has resulted in more patients undergoing sphincter-preserving surgery. Unfortunately, numerous patients subsequently experience bowel dysfunction, and may suffer from lifelong severe disability with major impact on their quality of life. The aim of the present study was to investigate whether the risk of severe LARS in patients was associated with the length of remnant rectum. METHODS A total of 125 patients who underwent sphincter-preserving surgery for rectal cancer were included. Postoperative bowel function was assessed using the low anterior resection syndrome (LARS) score a minimum of one year following surgery. The length of remnant rectum was measured on postoperative MRI of the pelvis and was correlated with the risk of having major LARS. RESULTS Overall, major LARS was observed in 38 per cent of patients. In the patients who underwent surgery alone, major LARS was reported by 27 per cent, and a larger remnant rectum was associated with a better functional outcome. In contrast, 80 per cent of patients who underwent combined preoperative chemoradiotherapy and surgery reported having major LARS. No association between the length of remnant rectum and the risk of major LARS was observed in patients treated with combined neoadjuvant therapy and surgery. CONCLUSION Both the length of remnant rectum and preoperative chemoradiotherapy had a major impact on the severity of bowel dysfunction after restorative rectal cancer surgery. No functional benefit from an irradiated rectal remnant was observed.
Collapse
Affiliation(s)
- P Bondeven
- Aarhus University Hospital, Department of Surgery P, Tage-Hansensgade 2, 8000 Aarhus, Denmark; Aarhus University Hospital, Department of Radiology, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - K J Emmertsen
- Aarhus University Hospital, Department of Surgery P, Tage-Hansensgade 2, 8000 Aarhus, Denmark
| | - S Laurberg
- Aarhus University Hospital, Department of Surgery P, Tage-Hansensgade 2, 8000 Aarhus, Denmark
| | - B G Pedersen
- Aarhus University Hospital, Department of Radiology, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| |
Collapse
|
46
|
Park SY, Choi GS, Park JS, Kim HJ, Ryuk JP, Yun SH. Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer: a case-matched comparison. World J Surg. 2014;38:1834-1842. [PMID: 24366278 DOI: 10.1007/s00268-013-2419-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Urinary and sexual dysfunction are recognized complications of rectal cancer surgery in men. This study compared robot-assisted total mesorectal excision (RTME) and laparoscopic total mesorectal excision (LTME) with regard to these functional outcomes. METHODS A series of 32 men who underwent RTME between February 1, 2009 and December 31, 2010 were matched 1:1 with patients who underwent LTME. The matching criteria were age, body mass index, tumor distance from the anal verge, neoadjuvant chemoradiation therapy, and tumor stage. Urinary and erectile function were evaluated using the International Prostatic Symptom Score (IPSS) and the five-item version of the International Index of Erectile Function (IIEF-5) scale. Data were collected from the two groups at baseline and at 3, 6, and 12 months after surgery and compared. RESULTS The mean IPSS score did not differ between the two groups at baseline at any point of measurement. The mean baseline IIEF-5 score was similar between the two groups and was decreased at 3 months. The mean IIEF-5 score was significantly higher in the RTME group at 6 months than in the LTME group (14.1 ± 6.1 vs. 9.4 ± 6.6; p = 0.024). The interval decrease in IIEF-5 scores was significantly higher in the LTME group than in the RTME group at 6 months (4.9 ± 4.5 vs. 9.2 ± 4.7; p = 0.030). CONCLUSIONS The men in the RTME group experienced earlier restoration of erectile function than did those in the LTME group. Bladder function was similar during the 12 months after RTME or LTME.
Collapse
|
47
|
Althumairi AA, Gearhart SL. Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond. J Gastrointest Oncol 2015; 6:296-306. [PMID: 26029457 DOI: 10.3978/j.issn.2078-6891.2015.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 12/13/2022] Open
Abstract
The goal of treatment for early stage rectal cancer is to optimize oncologic control while minimizing the long-term impact of treatment on quality of life. The standard of care treatment for most stage I and II rectal cancers is radical surgery alone, specifically total mesorectal excision (TME). For early rectal cancers, this procedure is usually curative but can have a substantial impact on quality of life, including the possibility of permanent colostomy and the potential for short and long-term bowel, bladder, and sexual dysfunction. Given the morbidity associated with radical surgery, alternative approaches to management of early rectal cancer have been explored, including local excision (LE) via transanal excision (TAE) or transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS). Compared to the gold standard of radical surgery, local procedures for strictly selected early rectal cancers should lead to identical oncological results and even better outcomes regarding morbidity, mortality, and quality of life.
Collapse
Affiliation(s)
- Azah A Althumairi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Susan L Gearhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| |
Collapse
|
48
|
Smith RK, Fry RD, Mahmoud NN, Paulson EC. Surveillance after neoadjuvant therapy in advanced rectal cancer with complete clinical response can have comparable outcomes to total mesorectal excision. Int J Colorectal Dis 2015; 30:769-74. [PMID: 25787162 DOI: 10.1007/s00384-015-2165-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE While the standard of care for patients with rectal cancer who sustain a complete clinical response (cCR) to chemoradiotherapy (CRT) remains proctectomy with total mesorectal excision, data suggests that non-operative management may be a safe alternative. The purpose of this study is to compare outcomes between patients treated with CRT that attained a cCR and opted for a vigilant surveillance to those of the patients who had a complete pathologic response (cPR) following proctectomy. METHOD This is a retrospective review of patients treated for adenocarcinoma of the rectum who achieved either a cCR or a cPR following CRT. Patients with a cCR were enrolled in an active surveillance program which included regularly scheduled exams, proctoscopy, serum carcinoembryonic antigen (CEA), endorectal ultrasound, and cross-sectional imaging. Outcomes were compared to those patients who underwent proctectomy with a cPR. Our primary outcome measures were post-treatment complications, recurrence, and survival. RESULTS We reviewed 18 patients who opted for surveillance after cCR and 30 patients who underwent proctectomy after a cPR. No non-operative patients had a documented treatment complication, while 17 patients with cPR suffered significant morbidity. There were two recurrences in the active surveillance group, one local and once distant, both treated by salvage resection with no associated mortality at 54 and 62 months. In the cPR group, one patient had a distant recurrence 24 months after surgery which was managed non-operatively. This patient died of unrelated causes 35 months after surgery. CONCLUSIONS Active surveillance can be a safe option that avoids the morbidity associated with proctectomy and preserves oncologic outcomes.
Collapse
Affiliation(s)
- Radhika K Smith
- Department of General Surgery, Temple University Health System, 3401 Broad St., Philadelphia, PA, 19140, USA
| | | | | | | |
Collapse
|
49
|
Jellison FC. Evaluation and Treatment of Overactive Bladder after History of Cancer Treatment. Curr Bladder Dysfunct Rep 2015. [DOI: 10.1007/s11884-014-0279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Park SY, Choi G, Park JS, Kim HJ, Park J, Choi JI. Efficacy and safety of udenafil for the treatment of erectile dysfunction after total mesorectal excision of rectal cancer: A randomized, double-blind, placebo-controlled trial. Surgery 2015; 157:64-71. [DOI: 10.1016/j.surg.2014.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 07/16/2014] [Indexed: 12/16/2022]
|