gms | German Medical Science

Introduction: With more survivors to expect by advanced surgical technique and multi-modal therapy, Quality of Life (QoL) becomes increasingly important in modern treatment of rectal cancer (RC). However, the standard surgical approach in terms of sphincter-preserving anterior resection (AR) was found non-superior to abdomino-perineal resection (APR), which may be attributed to poor functional outcome. To assess the impact of bowl dysfunction we evaluated QoL after AR in comparison with non-AR controls, right hemicolectomy for cancer (CC) and lay persons (healthy lays, HL), on long-term follow up.

Material and methods: We identified 293 RC patients receiving an AR between 1998 and 2008. From the same period, 201 CC patients receiving an oncologic colon resection and HL of the same age were used as a surgical and a non-surgical control group, respectively. Patients and lays were requested to answer the standardized EORTC QoL questionnaires QLQ-C 30 and –CR 38. Additionally, the estimated stool frequency per day should be stated.

Results: 116 QoL questionnaires from RC patients, 105 from CC patients and 103 from HL were evaluable. The global health status did not differ between the groups and was also found stable with the subgroup of RC patients receiving neoadjuvant treatment. As expected, defecation problems and diarrhea were significantly more frequent in RC patients compared with HL. The median stool frequency varied from 2.5 (range: 0.33-25) to 1.5 (range: 0.5-11) to 1 (range: 0.5-2) for RC, CC, and HL, respectively. Role functioning, future perspectives, and financial difficulties tended to poorer scores in the cancer groups, especially in CC, compared to HL. Interestingly, physical functioning was regarded better for RC and CC patients compared to lay persons.

Conclusion: Despite clear long-term symptoms associated with AR the global health status did not differ from controls. Worse functional outcome in terms of diarrhea and defecation problems did not result in worse QoL, even in case of multi-modal treatment. Interestingly, the knowledge of surviving cancer may be associated with a better physical functioning.