Pelvic organ function and quality of life after anastomotic leakage following rectal cancer surgery
ABSTRACT There is a paucity of studies assessing the influence of anastomotic leakage after rectal cancer surgery on pelvic organ function and quality of life.
Between 1995 and 2006, 500 patients underwent rectal resection for malignancies at a single institution. Thirty-six patients (7.2%) developed an anastomotic leakage postoperatively. Fifteen of these patients (41.6%) died during the follow-up period. A self-administering questionnaire including the International Index of Erectile Function, Female Sexual Function Index, Short Form-12 Health Survey, International Prostatic Symptom Score, International Consultation on Incontinence Questionnaire-Short Form, Vaizey Incontinence Score and Wexner Constipation Score was sent to all 21 alive patients. Patients with rectal cancer resection without leakage served as controls for each case and were matched by sex, age (±5 years), type of resection, and neoadjuvant therapy (yes/no).
Sixteen patients (76.2%) were available and were included in the analysis. The median follow-up time was 106.8 months (32.4-170.4). Fecal incontinence, constipation, and sexual function did not differ significantly between patients and controls (p = 0.1973, 0.1189, 0.8519, respectively). By contrast, urinary continence was impaired significantly in the leakage group (p = 0.0430) but not in control patients. The Quality of Life assessing Short Form-12 Health Survey reached no significant difference between both groups (p = 1.0000 and 0.1973).
Anastomotic leakage following anterior resection negatively aggravates urinary function but not fecal incontinence, constipation or sexual functions. The data indicate that patients experiencing anastomotic leakages can be relieved from the fear of gross pelvic floor function disturbances.
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ABSTRACT: Objective: To assess the impact of surgical harm on quality of life (QoL) in general and gastrointestinal surgery. Background: Surgical adverse events (SAEs) are associated with poor outcome. Although SAEs are likely to affect QoL, this has not been demonstrated in surgery. Methods: Studies in general and gastrointestinal surgery measuring postoperative QoL in patients who suffered SAEs were identified. The overall impact of SAEs on QoL scores was determined by combining results from different studies. Component scores, adjustment for confounders, and time trends were evaluated. Results: Data from 57,058 patients in 31 studies were analyzed. Most studies assessed the combined effect of different SAEs. High-quality studies adjusted for preoperative QoL. When different QoL instruments were scaled down to a common 0 to 1 score, the mean difference in QoL between SAE and no-SAE patients was 0.140 in esophagectomy, 0.110 in the Crohn resection, 0.089 in colorectal resection, 0.085 in gastric bypass, 0.072 in cholecystectomy, and 0.060 in inguinal hernia repair. Studies evaluating ileal pouch formation and antireflux surgery showed conflicting results. SAEs did not significantly affect QoL in emergency laparotomy and pancreatectomy. The frequency of SAEs was 5% to 48%. Physical QoL was affected more than emotional QoL. Conclusions: Significantly negative effects of SAEs on QoL were demonstrated in a range of procedures. Postoperative QoL seems to be a surrogate for the severity of impact of SAEs on patients. QoL may be an important utility to evaluate the economic and societal impact of SAEs thereby defining the threshold for safe practice.Journal of Surgical Research 05/2014; 260(6). DOI:10.1097/SLA.0000000000000676 · 2.12 Impact Factor
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ABSTRACT: Purpose: The impact of intraoperative complications on the postoperative outcome in rectal cancer surgery is only poorly studied in literature. Thus, the aim of the present study was to assess the frequency of intraoperative complications during rectal resections for malignancies and its influence on the short term outcome. Material and methods: We analyzed 605 consecutive patients, who had operations for rectal cancer at a single institution between 1995 and 2010. Retrospective data from the surgical procedure and postoperative course were obtained from the institutional colorectal database and individual chart reviews. Intraoperative complications were recorded and its influence on postoperative course was investigated. Results: Intraoperative complications occurred in 66 (10.9%) patients, with injury to the spleen (n = 35 of 66, 53%) being the most frequent complication. Patients with intraoperative complications had a significant longer hospital stay (median: 13 days, range 7-92) compared to patients without complications (median: 12 days, range 2-135; p = 0.0102). In addition, intraoperative complications showed a tendency towards an increased risk for postoperative surgical complications (p = 0.0536), whereas no impact on postoperative medical complications could be found (p = 0.8043). Pulmonary disorders were the only predictive marker for intraoperative complications (p = 0.0247) by univariate analysis. Conclusion: We found that intraoperative complications during rectal cancer surgery significantly prolonged hospital length stay. The overall morbidity rate was not affected.International Journal of Surgery (London, England) 07/2014; 12(8). DOI:10.1016/j.ijsu.2014.07.003 · 1.44 Impact Factor
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ABSTRACT: After total mesorectal excision (TME) with primary anastomosis for patients with rectal cancer, the quality of life (QoL) may be decreased due to fecal incontinence. This study aimed to identify predictors of fecal incontinence and related QoL. Patients who underwent TME with primary anastomosis for rectal cancer between December 2008 and June 2012 completed the fecal incontinence quality of life scale (FIQoL) and Wexner incontinence score. Factors associated with these scores were identified using a linear regression analysis. A total of 80 patients were included. Multivariate analysis identified a diverting ileostomy (n = 58) as an independent predictor of an unfavorable outcome on the FIQoL subscale coping/behavior (P = 0.041). Ileostomy closure within and after 3 months resulted in median Wexner scores of 5.0 (interquartile range [IQR], 2.5-8.0) and 10.5 (IQR, 6.0-13.8), respectively (P < 0.001). The median FIQoL score was 15.0 (IQR, 13.1-16.0) for stoma closure within 3 months versus 12.0 (IQR, 10.5-13.9) for closure after 3 months (P = 0.001). A diverting ileostomy is a predictor for an impaired FIQoL after a TME for rectal cancer. Stoma reversal within 3 months showed better outcomes than reversal after 3 months. Patients with a diverting ileostomy should be informed about the impaired QoL, even after stoma closure.