Quality of life after rectal resection for cancer, with or without colostomy
No apparent difference in quality of life in rectal cancer patients with a permanent stoma when compared to non-stoma patients. For patients diagnosed with rectal cancer, surgery is the definite treatment. The surgical outcome is either a restored bowel, or the formation of a stoma. Traditionally the formation of a colostomy has been regarded as an unfavourable outcome, as the quality of life of stoma patients is believed to be inferior compared to that in non-stoma patients. However, due to a pronounced variation of results between the eight included studies, this review was not able to support this assumption.
Available from: Frédéric Dumont
- "These disorders do not improve with time . However, patients who undergo APR do not suffer the common functional disorders associated with sphincter-preserving surgeries  , which sometimes offers them better emotional stability . Permanent abdominal stomas are deleterious only on specific areas of quality of life, and the choice of whether or not to perform sphincter-preserving surgery should not rely solely on a preconceived notion of the patient and/or of the surgeon that sphincter preservation is better for the quality of life . "
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ABSTRACT: The two goals of surgery for lower rectal cancer surgery are to obtain clear "curative" margins and to limit post-surgical functional disorders. The question of whether or not to preserve the anal sphincter lies at the center of the therapeutic choice. Histologically, tumor-free distal and circumferential margins of>1mm allow a favorable oncologic outcome. Whether such margins can be obtained depends of TNM staging, tumor location, response to chemoradiotherapy and type of surgical procedure. The technique of intersphincteric resection relies on these narrow margins to spare the sphincter. This procedure provides satisfactory oncologic outcome with a rate of circumferential margin involvement ranging from 5% to 11%, while good continence is maintained in half of the patients. The extralevator abdominoperineal resection provides good oncologic results, however this procedure requires a permanent colostomy. A permanent colostomy alters several domains of quality of life when located at the classical abdominal site but not when brought out at the perineal site as a perineal colostomy.
Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Available from: Beth K Potter
- "However, results for overall quality of life (QoL), despite being measured by various validated instruments, were consistently equivocal . Similarly, a recently updated Cochrane Review has revealed that low anterior resection (LAR) did not lead to superior QoL . Given the equivalent survival outcomes, and the need to weigh QoL outcomes, the decision for rectal cancer surgery is therefore a value-laden one that deserves the consideration of the patient perspective. "
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ABSTRACT: Colorectal cancer is common in North America. Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. A rectal cancer decision aid was developed using the International Patient Decision Aid Standards to facilitate patients being more actively involved in making this decision with the surgeon. The overall aim of this study is to evaluate this decision aid and explore barriers and facilitators to implementing in clinical practice.
First, a pre- and post- study will be guided by the Ottawa Decision Support Framework. Eligible patients from a colorectal cancer center include: 1) adult patients diagnosed with rectal cancer, 2) tumour at a maximum of 10 cm from anal verge, and 3) surgeon screened candidates eligible to consider both low anterior resection and abdominoperineal resection. Patients will be given a paper-version and online link to the decision aid to review at home. Using validated tools, the primary outcomes will be decisional conflict and knowledge of surgical options. Secondary outcomes will be patient's preference, values associated with options, readiness for decision-making, acceptability of the decision aid, and feasibility of its implementation in clinical practice. Proposed analysis includes paired t-test, Wilcoxon, and descriptive statistics.Second, a survey will be conducted to identify the barriers and facilitators of using the decision aid in clinical practice. Eligible participants include Canadian surgeons working with rectal cancer patients. Surgeons will be given a pre-notification, questionnaire, and three reminders. The survey package will include the patient decision aid and a facilitators and barriers survey previously validated among physicians and nurses. Principal component analysis will be performed to determine common themes, and logistic regression will be used to identify variables associated with the intention to use the decision aid.
This study will evaluate the impact of the rectal cancer decision aid on patients and help with planning strategies to overcome barriers and facilitate implementation of the decision aid in routine clinical practice. To our knowledge this is the first study designed to evaluate a decision aid in the field of colorectal surgery.
Available from: Hidehito Arimitsu
- "Over the last 20 years, the anal sphincter-preserving operation (SPO) has replaced abdominoperineal excision, becoming the procedure of choice for rectal cancers located near the anal sphincter.1 Even for patients in whom tumors are a definite indication for abdominoperineal excision, intersphincteric resection (ISR) has become an alternative approach with comparable tumor control.2 "
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ABSTRACT: Serotonin (5-hydroxytryptamine [5-HT])3 receptor antagonists are effective for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D), in which exaggerated intestinal/colonic hypermotility is often observed. Recent studies have suggested that the motility disorder, especially spastic hypermotility, seen in the neorectum following sphincter-preserving operations for rectal cancer may be the basis of the postoperative defecatory malfunction seen in these patients. We investigated the efficacy of 5-HT3 receptor antagonists in patients suffering from severe low anterior resection syndrome.
A total of 25 male patients with complaints of uncontrollable urgency or fecal incontinence following sphincter-preserving operations were enrolled in this study. Defecatory status, assessed on the basis of incontinence score (0-20), urgency grade (0-3), and number of toilet visits per day, was evaluated using a questionnaire before and 1 month after the administration of the 5-HT3 antagonist ramosetron.
All the parameters assessed improved significantly after taking ramosetron for 1 month. The effect was more prominent in cases whose anastomotic line was lower, ie, inside the anal canal. Defecatory function was better in patients who commenced ramosetron therapy within 6 months postoperatively, as compared to those who were not prescribed ramosetron for more than 7 months postoperatively.
These results suggest that 5-HT3 antagonists are effective for the treatment of low anterior resection syndrome, as in diarrhea-predominant irritable bowel syndrome. The improvement in symptoms is not merely time dependent, but it is related to treatment with 5-HT3 antagonists.
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