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: Für die Evaluation onkologischer Therapien gewinnen subjektive Parameter wie die Lebensqualität zunehmend an Bedeutung. Die Belastung des Patienten bspw. durch Schmerzen, Fatigue und soziale Krankheitsfolgen üben einen beträchtlichen Einfluss auf das Wohlergehen aus und können nur durch direkte Aussagen des Patienten selbst erfasst werden. Die routinemäßige Erhebung von Patient-Reported Outcomes (PROs) bietet mehrere Vorteile: die Identifikation von Beeinträchtigungen, Verbesserung der Arzt-Patienten-Kommunikation, umfangreichere Beurteilung des Behandlungserfolgs und die direkte Abstimmung von Interventionen auf die Bedürfnisse des Patienten. Für den breiten Einsatz in ambulanten und stationären Settings sind gut validierte Instrumente und adäquate Softwarelösungen verfügbar. Das Anwendungsspektrum von PROs aus der klinischen Routine ist umfangreich. Sie erlauben wissenschaftliche Analysen, tragen zur Qualitätssicherung bei und finden Verwendung im Health Technology Assessment.Wiener klinische Wochenschrift 05/2012; 124(9-10). DOI:10.1007/s00508-012-0168-3 · 0.79 Impact Factor
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ABSTRACT: BACKGROUND: There are still controversial data about the impact of rectal resection for malignancies on overall pelvic organ function and quality of life. Our aim was to investigate whether these parameters differ compared to the general population without bowel resection. METHODS: One hundred eighteen patients (44%) operated for rectal cancer at a single institution between 1995 and 2005 completed 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, and Vaizey Incontinence Score. Healthy subjects with no bowel resection served as controls for each case and were matched by age (±5 years) and gender. The median follow-up time was 7 years (range 2.8–14.2). RESULTS: The Vaizey incontinence score was significant higher in the patient group compared with the control group (patients: median 4 (range 0–24), controls: 0 (range 0–20); p<0.0001). Sexual and urinary function showed no significant difference between both groups. In regard to the SF-12 health survey the median physical health score of patients was 51.5 (range 22.0–58.2) compared to 53.6 (range 16.8–64.3) of the control subjects (p = 0.1241). The median mental health score of the patient group was 55.1 (range 19.1–63.8) compared to 55.0 (range 28.7–63.8) of the control group (p = 0.2222). CONCLUSIONS: Patients with rectal cancer resection have a significant impairment of fecal continence. Notably, urinary and sexual function and quality of life are comparable with healthy subjects without colorectal resection.European Surgery 01/2011; 44(1). DOI:10.1007/s10353-011-0036-9 · 0.26 Impact Factor
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ABSTRACT: The patient's perspective evaluated by patient-reported outcomes (PROs) gains more and more importance, since treatment efficacy is no longer solely linked to clinical outcomes like cure and overall survival. Ailments like pain, fatigue and social isolation can only be assessed by patients' direct expression without any interpretation made by medical staff. PROs facilitate the disclosure of quality of life issues and patients feel a stronger support due to improved communication. PROs offer many further advantages like saving of time, cost and staff, targeted intervention and sensitizing of clinicians. Also, internationally validated questionnaires are available and the development of electronic PROs eases data-collection, calculation and storage. PROs collected within clinical routine are versatile concerning their applicability: They can be used for scientific analyses, quality assurance, and health technology assessment.Wiener klinische Wochenschrift 04/2012; 124(9-10):293-303. · 0.79 Impact Factor