gms | German Medical Science

132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Functional outcome and quality of life after intersphincteric resection for low rectal cancer

Meeting Abstract

  • Johannes Klose - Universität Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Thomas Bruckner - Universität Heidelberg, Institut für medizinische Biometrie und Informatik, Heidelberg, Deutschland
  • Yakup Kulu - Universität Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Thomas Schmidt - Universität Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Martin Schneider - Universität Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Markus W. Büchler - Universität Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Alexis Ulrich - Universität Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch244

doi: 10.3205/15dgch244, urn:nbn:de:0183-15dgch2443

Published: April 24, 2015

© 2015 Klose et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Intersphincteric resection (ISR) for low rectal cancer represents a surgical approach to preserve sphincter function in contrast to abdominoperineal resection (APR) for patients with low rectal cancer. Although it is assumed that the oncological outcome between ISR and APR does not differ, the benefit of sphincter preserving surgery concerning functional outcome and its impact on patients’ quality of life (QoL) is still under debate. This study aimed to investigate sphincter function, QoL and oncological results of patients with low rectal cancer who underwent ISR.

Material and Methods: Patients who underwent ISR or APR for low rectal cancer between October 2001 and February 2013 were identified from a retrospective rectal cancer database. Postoperative complications were determined using Clavien-Dindo classification. The Wexner Score was used to assess sphincter function. QoL was determined using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR29 and CR30 questionnaires. Univariate and multivariate analysis using Cox regression was used to determine relevant clinical variables and independent predictors for postoperative outcome.

Results: 64 ISRs and 102 APRs were performed. Results of the Wexner Score indicated accumulated incidence of fecal incontinece among patients who underwent ISR. Global health status, urinary frequency and impotence were comparable between both groups. Postoperative complications were more often detected among patients in the APR group. Mean survival between both groups did not differ. Curative resection was associated with prolonged outcome in uni- and multivartiate analysis.

Conclusion: ISR for low rectal cancer achieves comparable oncological results to APR while perioperative morbidity is decreased. Although patients after ISR complained about limitations in daily life based on imparired urinary, fecal and sexual function, general satisfaction after surgery was observed in the majority of the patients. There is a trend towards better QoL after ISR compared to APR. Functional results are influenced by preoperative radiotherapy. ISR remains an important surgical technique for low rectal cancer. Functional deterioration should be discussed with the patient individually in advance to avoid disaffection and in respect to general satisfaction after surgery.