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Ágústsdóttir DH, Öberg S, Christophersen C, Oggesen BT, Rosenberg J. The Frequency of Urination Dysfunction in Patients Operated on for Rectal Cancer: A Systematic Review with Meta-Analyses. Curr Oncol 2024; 31:5929-5942. [PMID: 39451746 PMCID: PMC11505854 DOI: 10.3390/curroncol31100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/19/2024] [Accepted: 09/26/2024] [Indexed: 10/26/2024] Open
Abstract
The frequency of long-term urination dysfunction after surgery for rectal cancer remains unclear, yet it is essential to establish this to improve treatment strategies. Randomized controlled trials (RCTs), non-RCTs, and cohort studies were included with patients having undergone sphincter-preserving total (TME) or partial mesorectal excision (PME) for the treatment of primary rectal cancer in this review. The outcome was urination dysfunction reported at least three months postoperatively, both overall urination dysfunction and subdivided into specific symptoms. The online databases PubMed, Embase, and Cochrane CENTRAL were searched, bias was assessed using the Newcastle-Ottawa scale, and results were synthesized using one-group frequency meta-analyses. A total of 55 studies with 15,072 adults were included. The median follow-up was 29 months (range 3-180). The pooled overall urination dysfunction was 21% (95% confidence interval (CI) 12%-30%) 3-11 months postoperatively and 25% (95% CI 19%-32%) ≥12 months postoperatively. Retention and incontinence were common 3-11 months postoperatively, with pooled frequencies of 11% and 14%, respectively. Increased urinary frequency, retention, and incontinence seemed even more common ≥12 months postoperatively, with pooled frequencies of 37%, 20%, and 23%, respectively. In conclusion, one in five patients experienced urination dysfunction more than a year following an operation for rectal cancer.
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Affiliation(s)
- Dagný Halla Ágústsdóttir
- Center for Perioperative Optimization and Copenhagen Sequelae Center CARE, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark; (S.Ö.); (B.T.O.); (J.R.)
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Chen C, Zhang X, Li X, Wang YL. Clinical application of eight-zone laparoscopic dissection strategy for rectal cancer: Experience and discussion. World J Gastroenterol 2024; 30:3574-3583. [PMID: 39193567 PMCID: PMC11346151 DOI: 10.3748/wjg.v30.i30.3574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/05/2024] [Accepted: 07/24/2024] [Indexed: 08/08/2024] Open
Abstract
BACKGROUND The incidence of rectal cancer is increasing worldwide, and surgery remains the primary treatment modality. With the advent of total mesorectal excision (TME) technique, the probability of tumor recurrence post-surgery has significantly decreased. Surgeons' focus has gradually shifted towards minimizing the impact of surgery on urinary and sexual functions. Among these concerns, the optimal dissection of the rectal lateral ligaments and preservation of the pelvic floor neurovascular bundle have become critical. To explore the optimal surgical technique for TME and establish a standardized surgical protocol to minimize the impact on urinary and sexual functions, we propose the eight-zone dissection strategy for pelvic floor anatomy. AIM To compare the differences in surgical specimen integrity and postoperative quality of life satisfaction between the traditional pelvic floor dissection strategy and the innovative eight-zone dissection strategy. METHODS We analyzed the perioperative data of patients who underwent laparoscopic radical resection of rectal cancer at Qilu Hospital of Shandong University between January 1, 2021 and December 1, 2023. This study included a total of 218 patients undergoing laparoscopic radical surgery for rectal cancer, among whom 109 patients underwent traditional pelvic floor dissection strategy, and 109 patients received the eight-zone dissection strategy. RESULTS There were no significant differences in general characteristics between the two groups. Patients in the eight-zone dissection group had higher postoperative specimen integrity (88.1% vs 78.0%, P = 0.047). At the 3-month follow-up, patients in the eight-zone surgery group had better scores in urinary issues (6.8 ± 3.3 vs 5.3 ± 2.5, P = 0.045) and male sexual desire (2.2 ± 0.6 vs 2.5 ± 0.5, P = 0.047) compared to the traditional surgery strategy group. CONCLUSION This study demonstrates that the eight-zone dissection strategy for laparoscopic lateral ligament dissection of rectal cancer is safe and effective. Compared with the traditional pelvic floor dissection strategy, this approach can reduce the risk of nerve injury and minimize the impact on urinary and sexual functions. Therefore, we recommend the clinical application of this strategy to better serve patients with rectal cancer.
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Affiliation(s)
- Chang Chen
- Department of General Surgery, Rongchang People's Hospital, Chongqing 250012, China
| | - Xiang Zhang
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Xin Li
- Department of General Surgery, Huantai Branch of Qilu Hospital of Shandong University, Zibo 255000, Shandong Province, China
| | - Yan-Lei Wang
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
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Ghomeshi A, Zizzo J, Reddy R, White J, Swayze A, Swain S, Ramasamy R. The erectile and ejaculatory implications of the surgical management of rectal cancer. Int J Urol 2023; 30:827-837. [PMID: 37365839 PMCID: PMC11524142 DOI: 10.1111/iju.15235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
Colorectal cancer is a significant cause of cancer-related deaths worldwide. Although advances in surgical technology and technique have decreased mortality rates, surviving patients often experience sexual dysfunction as a common complication. The development of the lower anterior resection has greatly decreased the use of the radical abdominoperineal resection surgery, but even the less radical surgery can result in sexual dysfunction, including erectile and ejaculatory dysfunction. Improving the knowledge of the underlying causes of sexual dysfunction in this context and developing effective strategies for preventing and treating these adverse effects are essential to improving the quality of life for postoperative rectal cancer patients. This article aims to provide a comprehensive evaluation of erectile and ejaculatory dysfunction in postoperative rectal cancer patients, including their pathophysiology and time course and strategies for prevention and treatment.
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Affiliation(s)
- Armin Ghomeshi
- Herbert Wertheim College of MedicineFlorida International UniversityMiamiFloridaUSA
| | - John Zizzo
- University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Raghuram Reddy
- Herbert Wertheim College of MedicineFlorida International UniversityMiamiFloridaUSA
| | - Joshua White
- Desai Sethi Urology Institute, University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Aden Swayze
- Herbert Wertheim College of MedicineFlorida International UniversityMiamiFloridaUSA
| | - Sanjaya Swain
- Desai Sethi Urology Institute, University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of MedicineMiamiFloridaUSA
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Li X, Fu R, Ni H, Du N, Wei M, Zhang M, Shi Y, He Y, Du L. Effect of Neoadjuvant Therapy on the Functional Outcome of Patients With Rectal Cancer: A Systematic Review and Meta-Analysis. Clin Oncol (R Coll Radiol) 2023; 35:e121-e134. [PMID: 35940977 DOI: 10.1016/j.clon.2022.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/12/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
AIMS The impact of neoadjuvant therapy on the functional outcome of patients with resectable rectal cancer is still controversial. The aim of the present study was to explore the effects of neoadjuvant therapy on anorectal function (ARF), urinary function and sexual function in relevant patients. MATERIALS AND METHODS PubMed, Embase, Web of Science and the Cochrane Library were searched systematically. All English-language studies, published from January 2000 to July 2021, that explored the (postoperative) effects of neoadjuvant therapy versus upfront surgery on ARF, urinary function and sexual function of patients were included (PROSPERO 2021: CRD42021281617). RESULTS The data in this study were derived from 37 articles based on 33 studies; in total, 17 917 patients were enrolled. The meta-analysis revealed that the incidence of anorectal dysfunction in the neoadjuvant therapy group was significantly higher than that in the group of upfront surgery, which was manifested by a higher incidence of major low anterior resection syndrome (odds ratio = 3.09, 95% confidence interval = 2.48, 3.84; P < 0.001), reduction of mean squeeze pressure and mean resting pressure, and other manifestations, including clustering of stools, incontinence, urgency and use of pads. With the extension of follow-up time, the adverse effects of neoadjuvant therapy on major low anterior resection syndrome existed. Compared with patients undergoing upfront surgery, neoadjuvant therapy increased the risk of urinary incontinence (odds ratio = 1.31, 95% confidence interval = 1.00, 1.72; P = 0.05) and erectile dysfunction (odds ratio = 1.77, 95% confidence interval = 1.27, 2.45; P < 0.001). CONCLUSION Compared with upfront surgery, neoadjuvant therapy is not only associated with impairment of ARF, but also with increased incidence of urinary incontinence and male erectile dysfunction. However, the influence of confounding factors (e.g. surgical method, tumour stage) needs to be considered.
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Affiliation(s)
- Xiangyuan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haixiang Ni
- The Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Nannan Du
- Laboratory of Cell Engineering, Institute of Biotechnology, Beijing, China
| | - Mengfei Wei
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liwen Du
- Emergency Department, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
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Burch J, Taylor C, Wilson A, Norton C. Symptoms affecting quality of life after sphincter-saving rectal cancer surgery: A systematic review. Eur J Oncol Nurs 2021; 52:101934. [PMID: 33845303 DOI: 10.1016/j.ejon.2021.101934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Rectal cancer is common and is frequently treated with surgery which removes the rectum but retains anal sphincters. After sphincter-saving rectal cancer surgery, which can result in a reduced rectal storage capacity and nerve damage, symptoms frequently occur. METHOD A systematic review was undertaken to determine which symptoms occur and their effect on quality of life. Data from questionnaires and interviews were analysed thematically. RESULTS Fourteen heterogeneous studies were identified reporting both qualitative and quantitative data on over 1700 individuals. The most commonly reported symptoms related to bowel changes. The most problematic changes were bowel and sexual dysfunction. Quality of life was most affected by an inability to function as individuals desired, specifically in their chosen role and socially. Quality of life improved as time progressed or symptoms resolved; but symptoms could persist for many years. CONCLUSION After sphincter-saving rectal cancer surgery quality of life is affected by symptoms such as bowel dysfunction. Healthcare professionals need to gain a better understanding of which symptoms most bother individuals to enable patient-focussed interventions to be planned and improve quality of life.
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Affiliation(s)
- Jennie Burch
- St Mark's Hospital, Part of London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
| | - Claire Taylor
- St Mark's Hospital, Part of London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - Ana Wilson
- St Mark's Hospital, Part of London North West University Healthcare NHS Trust, Watford Road, Harrow, Middlesex, HA1 3UJ, UK; Imperial College, London, UK
| | - Christine Norton
- Kings College London, James Clerk Maxwell Building, 57 Waterloo Road, Lambeth, London, SE1 8WA, UK
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Ng KS, Gladman MA. Patient-reported and physician-recorded bowel dysfunction following colorectal resection and radical cystectomy: a prospective, comparative study. Colorectal Dis 2020; 22:1336-1347. [PMID: 32180323 DOI: 10.1111/codi.15041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/18/2020] [Indexed: 02/08/2023]
Abstract
AIM Bowel dysfunction following anterior resection (AR) is termed low anterior resection syndrome. It is unclear whether such dysfunction occurs following other bowel/pelvic operations as well. This study aimed to characterize and compare bowel dysfunction following AR, right hemicolectomy (RH) and radical cystectomy (RC). METHOD A prospective study of consecutive patients undergoing AR, RH and RC (2002-2012) was performed at a tertiary referral centre in Sydney, Australia. Outcome measures included (i) patient-reported satisfaction with bowel function, self-described bowel function and self-reported change in bowel function; (ii) objective assessment of bowel function using validated criteria to identify symptoms and stratify patients into those with constipation and/or faecal incontinence (FI); and (iii) health-related quality of life (SF-36v2 Health Survey). RESULTS Of 743 eligible patients, 70% participated [AR, n = 338, mean age 69.6 years (SD 11.9), 59% men; RH, n = 150, 75.8 years (SD 10.5), 54% men; RC, n = 34, 71.1 years (SD 14.1), 71% men]. AR patients were three times more likely to report change in bowel function post-surgery and self-judged their bowel function as abnormal more frequently (64%) than RH patients (35%) and RC patients (35%) (P < 0.01). AR patients were four times more likely to meet criteria for concomitant constipation and FI. Patients with concomitant constipation and FI had lower physical and mental SF-36v2 scores (P < 0.001). CONCLUSION Bowel dysfunction occurred after RH and RC but rates were higher following AR. This suggests that low anterior resection syndrome occurs due to a direct impact of partial/complete loss of the rectum rather than just due to loss of bowel length and/or the consequence(s) of pelvic dissection.
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Affiliation(s)
- K-S Ng
- Academic Colorectal Unit, Sydney Medical School - Concord, University of Sydney, Sydney, New South Wales, Australia
| | - M A Gladman
- Gastrointestinal and Enteric Neuroscience Research Group, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Eldamshety O, Kotb S, Khater A, Roshdy S, Elashry M, Zahi MS, Elkalla HMHR, Elnahas W, Farouk O, Fathi A, Senbel A, Hamed EE, Abdelwahab K, Elzahby IA, Abdallah A, Abdelaziz M, Lezoche E. Early and Late Functional Outcomes of Anal SphincterSparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma. Ann Coloproctol 2020; 36:148-154. [PMID: 32311866 PMCID: PMC7392569 DOI: 10.3393/ac.2018.07.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/19/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose The study aims to assess the functional outcome of anal sphincter-sparing procedures (SSP) with total mesorectal excision (TME) for anorectal adenocarcinoma. Methods In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME. Using the per anal examination scoring system (PASS), postoperative anal function was assessed after 1 year. Results Bowel motility time was 50±19 hours. The time needed for narcotic analgesia was 54±18.8 hours. Mean hospital stay was 15.4±10.25 days. Incidence of evident fecal incontinence after ISR is 10.6% (7 of 67 cases). The PASS findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in 1 case (1.4%). Temporary diversion was performed in 61 patients (87.1%). Conclusion Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides reasonable functional outcomes. PASS is a new application for postoperative assessment of anal function.
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Affiliation(s)
- Osama Eldamshety
- surgical oncology, oncology centre, Mansoura university, Elmansoura, Egypt
| | - Sherif Kotb
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Ashraf Khater
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Sameh Roshdy
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Mohamed Elashry
- Department of clinical oncology and nuclear medicine, Mansoura University, Mansoura, Mansoura, Egypt
| | - Mohamed S Zahi
- Department of clinical oncology and nuclear medicine, Mansoura University, Mansoura, Mansoura, Egypt
| | | | - Waleed Elnahas
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Adel Fathi
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Ahmed Senbel
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Emad-Eldeen Hamed
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Khaled Abdelwahab
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | | | - Ahmed Abdallah
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Mahmoud Abdelaziz
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Emanuele Lezoche
- Surgery department, Policlinico Umberto primo, Sapienza University of Rome, Rome, Italy
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Fomenko OY, Kashnikov VN, Alekseev MV, Veselov AV, Belousova SV, Aleshin DV, Morozov SV, Kozlov VA, Reutova AA, Rumiantsev AS, Nafedzov IO. [Rehabilitation program for patients with low anterior resection syndrome]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2020; 97:52-59. [PMID: 33054009 DOI: 10.17116/kurort20209705152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Surgical treatment of rectal cancer and sphincter-preserving low anterior resection results to evacuation disorders («low anterior resection syndrome» - LARS). There are no clinical recommendations for the treatment of patients with LARS as well as a rehabilitation program for them. OBJECTIVE To develop a rehabilitation program for patients with low anterior resection syndrome. MATERIAL AND METHODS The investigation was performed at 2 stages. During the first stage, 29 patients with LARS (17 (58.6%) men, mean age of the participants' 61.5±9.5 years), 12 (41.4%) women (mean age 61.2±7.8 years) were examined and received the course of conservative treatment with the use of biofeedback-therapy performed by the standard protocol. On the second stage, 17 patients (mean age 61.4±12.7 years) - 9 (52.9%) men, 8 (47.1%) women received biofeedback therapy in combination with tibial neuromodulation (TNM). Functional state of the rectum and the locking apparatus in all patients were evaluated by anorectal manometry: sphincterometry and studies of the reservoir function of the rectum before and after treatment. RESULTS The developed complex of rehabilitation measures led to improved treatment results for patients with rectal cancer by improving the quality of life after low anterior resection, reducing the manifestations of LARS (by 47.8%). Stable positive results of treatment were maintained in 36.4% of patients, positive dynamics from the treatment according to the LARS scale decreased slightly in 54.5%, deterioration of indicators in 3-6 months after conservative rehabilitation was registered in 9.1% of cases. At the first stage maximal squeeze pressure improvement was reached in the whole cohort (p=0.047), at the second stage these trend was seen only for women for the pressure values at rest (p=0.01) and during squeeze (p=0.025). The data obtained allowed us to recommend a repeat course of treatment to 63.6% of patients. The authors modified and optimized a special complex of physical therapy for the rehabilitation of patients both in a medical institution and at home. These exercises are aimed at improving the functional state of the pelvic floor muscles and sphincter apparatus. CONCLUSION Rehabilitation program for patients with low anterior resection syndrome should include: 1) biofeedback therapy to improve the holding function; 2) biofeedback therapy aimed at improving the reservoir function and sensitivity of the rectum to filling; 3) tibial neuromodulation. This program may help improving the contractility of the anal sphincter and reservoir function of the rectum, as well as the appearance of the urge to defecate.
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Affiliation(s)
- O Yu Fomenko
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - V N Kashnikov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - M V Alekseev
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - A V Veselov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - S V Belousova
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - D V Aleshin
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - S V Morozov
- Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - V A Kozlov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - A A Reutova
- State clinical hospital No. 67 named after L.A. Vorokhobov, Moscow, Russia
| | - A S Rumiantsev
- State clinical hospital No. 67 named after L.A. Vorokhobov, Moscow, Russia
| | - I O Nafedzov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
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Lupattelli M, Mascioni F, Bellavita R, Draghini L, Tarducci R, Castagnoli P, Russo G, Aristei C. Long-term Anorectal Function after Postoperative Chemoradiotherapy in High-Risk Rectal Cancer Patients. TUMORI JOURNAL 2018; 96:34-41. [DOI: 10.1177/030089161009600106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aims and background After sphincter-preserving surgery for rectal cancer and postoperative radiochemotherapy, many patients have unsatisfactory anorectal functional results which are not considered by the most common toxicity scales. The aim of the present study was to retrospectively assess the long-term incidence of impaired anorectal function in rectal cancer patients who underwent anterior resection and postoperative radiochemotherapy. Methods Ninety-nine patients who underwent sphincter-saving surgery and postoperative radiochemotherapy for stage II-III rectal cancer from July 1991 to January 2002 were given a questionnaire on anorectal function. Postoperative incontinence was evaluated according to a scale proposed by Jorge and Wexner. Factors influencing anorectal function were examined. Results The median follow-up from surgery was 10 years. Ten (10.1%) patients reported ≥ 5 bowel movements per day and 26 (26.3%) experienced clustering. The median frequency of bowel movements per 24 h was 2 (range, 1–10). Stool fragmentation was recorded in 56 (56.6%) cases, and 36 (36.4%) patients experienced urgency to defecate with inability to delay defecation for more than 15 min. The mean continence score was 4.91 (median 1, range 0–18). Incontinence to flatus, liquid and solid stools was reported at least once a week in 24 (24.2%), 11 (11.1%) and 5 (5.1%) patients, respectively. According to the study criteria, 61% of patients had good functional results. None of the variables analyzed showed a significant correlation with functional outcome. Conclusions Although retrospective, the present study included a large selected series that had undergone uniform adjuvant treatment and was followed for a median of 10 years. Our data demonstrated that 39% of patients did not have good functional results and suffered some degree of urgency, increased frequency and occasional incontinence even many years after the surgery. Anorectal function assessment should enter routinely in clinical practice and should have importance in the therapeutic decisions.
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Affiliation(s)
- Marco Lupattelli
- Radiation Oncology Centre, University and Hospital of Perugia, Perugia, Italy
| | - Francesca Mascioni
- Radiation Oncology Centre, University and Hospital of Perugia, Perugia, Italy
| | - Rita Bellavita
- Radiation Oncology Centre, University and Hospital of Perugia, Perugia, Italy
| | - Lorena Draghini
- Radiation Oncology Centre, University and Hospital of Perugia, Perugia, Italy
| | - Roberto Tarducci
- Medical Physics, University and Hospital of Perugia, Perugia, Italy
| | - Paolo Castagnoli
- Surgery Division, University and Hospital of Perugia, Perugia, Italy
| | - Giuseppe Russo
- Department of Gastroenterology, University and Hospital of Perugia, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Centre, University and Hospital of Perugia, Perugia, Italy
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10
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Attaallah W, Ertekin SC, Yegen C. Prospective study of sexual dysfunction after proctectomy for rectal cancer. Asian J Surg 2017; 41:454-461. [PMID: 28800864 DOI: 10.1016/j.asjsur.2017.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/04/2017] [Accepted: 04/18/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although rectal cancer is a common malignancy and has an improved cure rate in response to oncological treatment, research on rectal-cancer survivors' sexual function remains limited. OBJECTIVE The aim of this prospective study is to assess sexual dysfunction after rectal cancer surgery. PATIENTS AND METHODS Patients undergoing curative rectal cancer surgery were included in the study. Sexual function before and 6 months after the operation was measured using the validated questionnaires. Primary outcome was to determine the rates of Sexual dysfunction after rectal cancer surgery. Furthermore, the factors which can have an impact on sexual function after radical treatment have been assessed. RESULTS A total of 187 patients [117 (63%) men and 70 (37%) women] with rectal cancer who underwent radical resection were included in the study. Sexual function has significantly decreased after surgery. Among male patients, sexual dysfunction increased from the baseline 4% (n = 5) up to 41% (n = 48) after the operation. Among female patients, sexual dysfunction increased from the baseline 53% (n = 37) up to 77% (n = 54) after the operation. A significant lower rate of laparoscopic surgery has been found in both males and females who reported sexual dysfunction after surgery. The patients who have locally advanced disease and those who received postoperative chemotherapy or radiotherapy have higher rates of sexual dysfunction. CONCLUSION This study, showed that sexual dysfunction is common in patients with rectal cancer after radical treatment. However, patients who underwent laparoscopic surgery have lower rates of sexual dysfunction than those who underwent open surgery.
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Affiliation(s)
- Wafi Attaallah
- Marmara University School of Medicine, Department of General Surgery, Istanbul, Turkey.
| | | | - Cumhur Yegen
- Marmara University School of Medicine, Department of General Surgery, Istanbul, Turkey
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11
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Shieh SI, Lin YH, Huang CY, Kao CC, Hung SL, Yang HY, Tung HY. Sexual dysfunction in males following low anterior resection. J Clin Nurs 2016; 25:2348-56. [PMID: 27080210 DOI: 10.1111/jocn.13172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore the prevalence of sexual dysfunction in males one year after undergoing low anterior resection and to determine whether health care professionals discuss sexual issues with patients after surgery. BACKGROUND Sexual dysfunction in males may be a complication after low anterior resection for rectal cancer, but few studies have explored this issue in Taiwan. DESIGN A descriptive comparison study design. METHODS A descriptive comparison design was used, and a group of 133 participants underwent a low anterior resection procedure for rectal cancer. The results were compared with those of a group of males who underwent colectomy (n = 58) for colon cancer. The following instruments were used: the five-item version of the International Index of Erectile Function, personal demographics and medical variables. RESULTS The results showed that the prevalence of erectile dysfunction among the low anterior resection patients was 97·0% (129/133), and the erectile dysfunction prevalence was 75·9% (44/58) for the males who underwent colectomy. The generalised linear model showed that after controlling for hypertension and stoma, the low anterior resection group had worse sexual function than those in the colectomy group, and stoma was also a factor that impacted patients' sexual function. The results also revealed that only 32·8-35·3% of health care providers talked about sexual dysfunction with people who have rectal cancer prior to surgery. CONCLUSION This study demonstrated that men who have undergone low anterior resection have a high risk of sexual dysfunction and that health care professionals infrequently discuss these issues with patients. RELEVANCE TO CLINICAL PRACTICE When patients are diagnosed with rectal cancer and before they undergo surgery, an assessment and discussion of sexual function issues should be incorporated into standard care. Continued follow-up after hospital discharge and evaluations of sexual function are vital factors for male postoperative rectal cancer patients.
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Affiliation(s)
- Show-Ing Shieh
- College of Liberal Education, Shu-Te University, Kaohsiung, Taiwan
| | - Yu-Hua Lin
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | | | - Chia-Chan Kao
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Ling Hung
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Hsing-Yu Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Hong-Yu Tung
- Medical Education & Research Department, Yuan's General Hospital, Kaohsiung, Taiwan
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Talaeezadeh A, Bahadoram M, Abtahian A, Rezaee A. Extended Low Anterior Resection with a Circular Stapler in Patients with Rectal Cancer: a Single Center Experience. Asian Pac J Cancer Prev 2016; 16:8141-3. [DOI: 10.7314/apjcp.2015.16.18.8141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Fecal Incontinence and Quality of Life in Adults With Rectal Cancer After Lower Anterior Resection. J Wound Ostomy Continence Nurs 2015; 42:395-400. [DOI: 10.1097/won.0000000000000135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Lin YH, Yang HY, Hung SL, Chen HP, Liu KW, Chen TB, Chi SC. Effects of pelvic floor muscle exercise on faecal incontinence in rectal cancer patients after stoma closure. Eur J Cancer Care (Engl) 2015; 25:449-57. [PMID: 25684312 DOI: 10.1111/ecc.12292] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine the effects of pelvic floor muscle exercise (PFME) on the faecal incontinence (FI) of rectal cancer patients following stoma closure. Participants were randomly distributed into an exercise group (n = 27) and non-exercise group (n = 26). An experimental design and longitudinal approach were implemented for data collection. Baseline data were collected at 1 day before discharge, and then PFME was taught before the patients were discharged from the hospital. We collected data and followed up with the patients at their pre-discharge visit and at 1, 2, 3, 6 and 9 months after discharge. The Cleveland Clinic Faecal Incontinence (CCI) score was used to measure patient outcome. PFME proved to effectively decrease the degree of FI in stoma closure recipients. The FI score of the exercise group significantly decreased from 8.37 to 2.27 after PFME compared with that of the non-exercise group (from 8.54 to 2.58). The generalised estimation equation tests showed that both group and time were significantly different. The tests also indicated that although PFME appeared to hasten the decline of incontinence, this effect was no longer detectable at 9 months; thus, it may be an effective intervention for FI when implemented up to half a year after discharge.
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Affiliation(s)
- Y-H Lin
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - H-Y Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - S-L Hung
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - H-P Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-DA Hospital, Kaohsiung, Taiwan
| | - K-W Liu
- Division of Colon and Rectal Surgery, Department of Surgery, E-DA Hospital, Kaohsiung, Taiwan
| | - T-B Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, Kaohsiung, Taiwan
| | - S-C Chi
- Nursing Department, E-DA Hospital, Kaohsiung, Taiwan
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15
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Bregendahl S, Emmertsen KJ, Lindegaard JC, Laurberg S. Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis 2015; 17:26-37. [PMID: 25156386 DOI: 10.1111/codi.12758] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/29/2014] [Accepted: 07/15/2014] [Indexed: 02/08/2023]
Abstract
AIM Knowledge of urinary and sexual dysfunction in women after rectal cancer treatment is limited. This study addresses this in relation to the use of preoperative radiotherapy, type of surgery and the presence of bowel dysfunction. METHOD All living female patients who underwent abdominoperineal excision (APE) or low anterior resection (LAR) for rectal cancer in Denmark between 2001 and 2007 were identified. Validated questionnaires (the ICIQ-FLUTS and the SVQ) on urinary and sexual function were completed by 516 (75%) and 482 (72%) recurrence-free patients in 2009. RESULTS Urgency and incontinence were reported by 77 and 63% of respondents, respectively. Vaginal dryness, dyspareunia and reduced vaginal dimensions occurred in 72, 53 and 29%, respectively, and 69% reported that they had little/no sexual desire. Preoperative radiotherapy was associated with voiding difficulties (OR = 1.63, 95% CI 1.09-2.44), reduced vaginal dimensions (OR = 4.77, 95% CI 1.97-11.55), dyspareunia (OR = 2.76, 95% CI 1.12-6.79), lack of desire (OR = 2.22, 95% CI 1.09-4.53) and reduced sexual activity (OR = 0.55, 95% CI 0.30-0.98). Patients undergoing APE had a higher risk of dyspareunia (OR = 2.61, 95% CI 1.00-6.85). Bowel dysfunction after LAR was associated with bladder storage difficulties (OR = 1.64, 95% CI 1.01-2.65), symptoms of incontinence (OR = 2.17, 95% CI 1.35-3.50), lack of sexual desire (OR = 2.69, 95% CI 1.21-5.98), sexual inactivity (OR = 0.48, 95% CI 0.24-0.96) and sexual dissatisfaction (OR = 0.40, 95% CI 0.20-0.82). CONCLUSION Urinary and sexual problems are common in women after treatment for rectal cancer. Preoperative radiotherapy interferes with several aspects of urinary and sexual functioning. Bowel dysfunction after LAR is associated with urinary dysfunction and a reduction in sexual desire, activity and satisfaction.
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Affiliation(s)
- S Bregendahl
- Surgical Research Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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Planting A, Phang PT, Raval MJ, Brown CJ. Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life. Can J Surg 2013; 56:243-8. [PMID: 23883494 DOI: 10.1503/cjs.028411] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Anal dilation during tumour excision with transanal endoscopic microsurgery (TEM) has caused concerns regarding postoperative anal function. We sought to determine whether TEM affects anorectal function and quality of life. METHODS All patients undergoing TEM between March 2007 and December 2008 were considered for inclusion. We excluded patients who were treated with subsequent radical resection, unavailable for interview or deceased. Patients were interviewed by phone to measure the preoperative and postoperative function using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Core 30 (EORTC QLQ-C30) and Core 38 (CR38) instruments, the Fecal Incontinence Severity Index (FISI) and the Fecal Incontinence Quality of Life (FIQL) questionnaires. Statistical analysis involved the Wilcoxon signed rank test and Spearman rank correlation coefficient. RESULTS Forty patients received TEM; 30 of them met all inclusion criteria and agreed to participate. The median age was 70 (42-93) years, and median follow-up time between the interview and the operation was 365 (55-712) days. Tumours excised included 19 adenomas, 8 carcinomas and 3 carcinoid tumours. The median distance from the tumour to the anal verge was 6.5 (2-13) cm. Median length of stay was 1 (0-12) day. For most aspects of quality of life, there were no detectable differences after surgery. The EORTC QLQ-C30 showed a significant improvement in diarrhea (27.8 v. 10, p = 0.002). The FIQL scores improved with surgery (3.59 v. 3.85, p = 0.020). There was no difference in pre- versus postoperative FISI scores (6.7 v. 6.3, p = 0.93). CONCLUSION Despite a large operating rectoscope, TEM improves quality of life related to fecal incontinence and does not have a negative impact on fecal continence.
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Affiliation(s)
- Anneke Planting
- Department of Surgery, St Paul's Hospital, Vancouver and the University of British Columbia, Vancouver, BC
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Baek JH, Alrubaie A, Guzman EA, Choi SK, Anderson C, Mills S, Carmichael J, Dagis A, Qian D, Kim J, Garcia-Aguilar J, Stamos MJ, Bening L, Pigazzi A. The association of hospital volume with rectal cancer surgery outcomes. Int J Colorectal Dis 2013; 28:191-6. [PMID: 22842664 DOI: 10.1007/s00384-012-1536-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE An association between hospital volume and postoperative mortality has been identified for several oncologic surgical procedures. Our objective was to analyze differences in surgical outcomes for patients with rectal cancer according to hospital volume in the state of California. METHODS A cross-sectional study from 2000 to 2005 was performed using the state of California Office of Statewide Health Planning and Development database. Hospitals were categorized into low (≤30)-, medium (31-60)-, and high (>60)-volume groups based on the total number of rectal cancer operations performed during the study period. RESULTS Overall, 7,187 rectal cancer operations were performed. Of the 321 hospitals in the study cohort, 72 % (n = 232), 20 % (n = 65), and 8 % (n = 24) were low-, medium-, and high-volume hospitals, respectively. Postoperative mortality was significantly lower- in high-volume hospitals (0.9 %) when compared to medium- (1.1 %) and low-volume hospitals (2.1 %; p < 0.001). High-volume hospitals also performed more sphincter-preserving procedures (64 %) when compared to medium- (55 %) and low-volume hospitals (51 %; p < 0.001). CONCLUSIONS These data indicate that hospital volume correlates with improved outcomes in rectal cancer surgery. Rectal cancer patients may benefit from lower mortality and increased sphincter preservation in higher-volume centers.
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Affiliation(s)
- Jeong-Heum Baek
- City of Hope National Medical Center, General and Oncologic Surgery, Duarte, CA, USA
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18
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Loos M, Quentmeier P, Schuster T, Nitsche U, Gertler R, Keerl A, Kocher T, Friess H, Rosenberg R. Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol 2012; 20:1816-28. [PMID: 23269466 DOI: 10.1245/s10434-012-2827-z] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Preoperative radio(chemo)therapy (pR(C)T) significantly reduces the local recurrence risk and is therefore recommended in stage II/III rectal cancer. However, this multimodal treatment approach may be associated with late adverse effects. To determine the impact of pR(C)T on long-term anorectal, sexual, and urinary function, we performed a systematic review and meta-analysis. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for studies reporting on long-term functional outcome after rectal cancer resection with pR(C)T. Only studies that reported anorectal, sexual, and/or urinary function after rectal cancer resection in TME-technique with pR(C)T were eligible for inclusion. RESULTS Twenty-five studies, including 6,548 patients, were identified. Methodological quality of the eligible studies was low. The majority of studies reported higher rates of anorectal (14/18 studies) and male sexual dysfunction (9/10 studies) after pR(C)T. Few studies examined female sexual dysfunction (n = 4). Meta-analysis revealed that stool incontinence occurred more often in irradiated patients (risk ratio (RR) = 1.67; 95 % confidence interval (CI), 1.36, 2.05; p < 0.0001) and manometric results were significantly worse after pR(C)T (mean resting pressures (weighted mean difference (WMD) = 15.04; 95 % CI, 0.77, 29.31; p = 0.04) and maximum squeeze pressures (WMD = 30.39; 95 % CI, 21.48, 39.3; p < 0.0001)). Meta-analysis of erectile dysfunction revealed no statistical significance (RR = 1.41; 95 % CI, 0.74, 2.72; p = 0.3). Six of eight studies and meta-analysis demonstrated no negative effect of pR(C)T on urinary function (RR = 1.05; 95 % CI, 0.67, 1.65; p = 0.82). CONCLUSIONS Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME.
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Affiliation(s)
- Martin Loos
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany,
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Demographics, cancer-related factors, and sexual function in rectal cancer patients in Taiwan: preliminary findings. Cancer Nurs 2012; 35:E17-25. [PMID: 22067695 DOI: 10.1097/ncc.0b013e318233a966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sexual function has been ignored because survival issues associated with cancer treatment commonly take precedence over sexual issues. Sexual dysfunction remains a recognized complication after cancer treatment despite improvement in survival rates for patients with rectal cancer. OBJECTIVE This study investigated the relationships among demographics (ie, age, gender, education, religion) and cancer-related factors (ie, stage of disease, type of treatment, time since operation, comorbid conditions) and sexual function in patients with rectal cancer. METHODS A cross-sectional study with a convenience sample of 120 rectal cancer patients from a medical center in southern Taiwan completed the International Index of Erectile Function, Female Sexual Function Index, a demographic questionnaire, and medical data during face-to-face interviews. RESULTS In both men and women, better sexual function was significantly associated with younger age but not with religion, time since operation, or number of chronic conditions. In men only, better sexual function was associated with earlier stage of cancer, fewer cancer treatments, and higher education. CONCLUSION Sexual function may receive greater attention in Taiwan when rectal cancer patients receive appropriate care. A larger diverse sample is needed for further examination of sexual function over time. IMPLICATIONS FOR PRACTICE Health promotion programs for long-term survivors should include a consistent assessment of sexual function before and after an operation, and patients should receive clinical sexual counseling.
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Traa MJ, De Vries J, Roukema JA, Den Oudsten BL. Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 2012; 23:19-27. [PMID: 21508174 DOI: 10.1093/annonc/mdr133] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To determine (i) the prevalence of sexual (dys)function in patients with colorectal cancer and (ii) treatment-related and sociodemographic aspects in relation to sexual (dys)function and the quality of sexual life. Recommendations for future studies are provided. METHODS A systematic search was conducted during the period 1990 to July 2010 that used the databases PubMed, PsychINFO, The Cochrane Library, EMBASE, and OVID Medline. RESULTS Eighty-two studies were included. The mean quality score was 7.2. The percentage of preoperatively potent men that experienced sexual dysfunction postoperatively varied from 5% to 88%. Approximately half of the women reported sexual dysfunction. Preoperative radiotherapy, a stoma, complications during or after surgery, and a higher age predicted more sexual dysfunction with a strong level of evidence. Type of surgery and a lower tumor location predicted more sexual dysfunction with a moderate level of evidence. Insufficient evidence existed for predictors of the quality of sexual life. Current studies mainly focus on biological aspects of sexual (dys)function. Furthermore, existing studies suffer from methodological shortcomings such as a cross-sectional design, a small sample size, and the use of nonstandardized measurements. CONCLUSION Sexuality should be investigated prospectively from a biopsychosocial model, hereby including the quality of sexual life.
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Affiliation(s)
- M J Traa
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - J De Vries
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Medical Psychology
| | - J A Roukema
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Surgery
| | - B L Den Oudsten
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Departments of Education and Research, St Elisabeth Hospital, Tilburg, The Netherlands.
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Landers M, McCarthy G, Savage E. Bowel symptom experiences and management following sphincter saving surgery for rectal cancer: A qualitative perspective. Eur J Oncol Nurs 2011; 16:293-300. [PMID: 21813325 DOI: 10.1016/j.ejon.2011.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 06/11/2011] [Accepted: 07/09/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE OF THE RESEARCH The aim of this research was to explore participants' qualitative perspectives on bowel symptom experiences and management strategies following sphincter saving surgery for rectal cancer. METHODS AND SAMPLE The data presented in this paper were gleaned from a semi-structured question that formed part of a larger multi-site quantitative correlational study. From a sample of 143 participants, a total of 77 (62.6%) males and 46 (37.3%) females provided qualitative comments. Participants were aged 30-70 years and over, had undergone sphincter saving surgery for rectal cancer in the past 3-42 months. Data were analysed using pre-determined semi-structured categories. KEY RESULTS The study demonstrated the subjective nature of the bowel symptoms experienced. It also highlighted the bowel symptoms that were most problematic and the effect of these symptoms on participants' daily lives. In addition, the self-care strategies that worked best for individual participants in the management of bowel symptoms were identified. CONCLUSIONS There is a need to educate patients on the short-term as well as the long-term bowel symptoms experienced following sphincter saving surgery for rectal cancer. Nurses have an important contribution to make in facilitating patients to choose from a range of self-care strategies to help them manage their bowel symptoms postoperatively.
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Affiliation(s)
- Margaret Landers
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Ireland.
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Bossema ER, Seuntiëns MWM, Marijnen CAM, Baas-Thijssen MCM, van de Velde CJH, Stiggelbout AM. The relation between illness cognitions and quality of life in people with and without a stoma following rectal cancer treatment. Psychooncology 2010; 20:428-34. [PMID: 20878851 DOI: 10.1002/pon.1758] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 03/15/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare health-related quality of life, emotional functioning and illness cognitions between people with and without a stoma after rectal cancer treatment about 8 years ago and to examine the relation between illness cognitions and health-related quality of life and emotional functioning. METHODS Sixty-two people who had undergone abdominoperineal resection with a permanent stoma and 60 people who had undergone low anterior resection without a permanent stoma participated. Questionnaires included the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30, the Hospital Anxiety and Depression Scale, and the Illness Cognition Questionnaire. RESULTS There were no significant differences between people with and without a stoma in health-related quality of life, emotional functioning and illness cognitions. There were moderate and significant relations between the illness cognitions helplessness (negative) and disease acceptance (positive) on the one hand and health-related quality of life and emotional functioning on the other. For helplessness this relation barely differed between people with and without a stoma, but for disease acceptance this relation was stronger for people without a stoma than for people with a stoma. CONCLUSIONS The study showed no differences in health-related quality of life, but a stronger relation between disease acceptance and health-related quality of life for people without a stoma than for people with a stoma. If this relation is causal, people with negative illness cognitions after rectal cancer treatment might be identified and offered help.
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Affiliation(s)
- Ercolie R Bossema
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
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Song PH, Yun SM, Kim JH, Moon KH. Comparison of the erectile function in male patients with rectal cancer treated by preoperative radiotherapy followed by surgery and surgery alone. Int J Colorectal Dis 2010; 25:619-24. [PMID: 20169350 DOI: 10.1007/s00384-010-0879-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE This study evaluates the erectile function of male patients treated by preoperative radiotherapy followed by surgery and surgery alone for locally advanced rectal cancer. METHODS A total of 112 men treated by total mesorectal excision with autonomic nerve preservation were included. Seventy-three patients were treated by preoperative radiotherapy followed by surgery (RTS group), and 39 were treated by surgery alone (surgery group). Patients filled out the five-item version of the international index of erectile function (IIEF-5) questionnaire at least 6 months after initial erectile function assessment. We analyzed the impact of age, surgery type, location, and size of tumor on erectile function. RESULTS Total score was decreased significantly at follow-up compared to initial assessment in both RTS and surgery group (20.31 +/- 4.39 vs. 11.52 +/- 4.83, P = 0.012; 19.86 +/- 4.61 vs. 14.07 +/- 6.37, P = 0.031, respectively). Score difference was statistically higher in RTS group compared with surgery group (P = 0.028). In terms of surgery type for RTS group, score difference was statistically higher in the patients with abdominoperineal resection (APR) compared with those with lower anterior resection (P = 0.023). In comparison of score difference according to tumor location, difference was statistically higher in the patients with lower rectal cancer compared with those with upper rectal cancer (P = 0.017). CONCLUSION The erectile functions of patients treated by preoperative radiotherapy followed by surgery are more affected than that of patients treated by surgery alone in locally advanced rectal cancer. Also APR and lower rectal cancer were significantly associated with erectile dysfunction in the patients treated by preoperative radiotherapy followed by surgery.
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Affiliation(s)
- Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, 317-1 Daemyung-dong, Nam-gu, Daegu, 705-035, South Korea.
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Ellis R, Smith A, Wilson S, Warmington S, Ismail T. The Prevalence of Erectile Dysfunction in Post-Treatment Colorectal Cancer Patients and Their Interests in Seeking Treatment: A Cross-Sectional Survey in the West-Midlands. J Sex Med 2010; 7:1488-96. [DOI: 10.1111/j.1743-6109.2009.01461.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tomita R. Sacral Nerve Terminal Motor Latency in Patients With or Without Soiling More Than 2 Years After Low Anterior Resection for Low Rectal Cancer. World J Surg 2009; 33:1495-501. [DOI: 10.1007/s00268-009-0035-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ma J, Feng Y, Cong JC, Liu EQ. Influence of anastomosis level on defection and life quality of patients underwent sphincter preservation for rectal cancer. Shijie Huaren Xiaohua Zazhi 2009; 17:221-224. [DOI: 10.11569/wcjd.v17.i2.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the influence of anastomosis level on defection and quality of life in low rectal cancer using a questionnaire and anus-rectal manometry.
METHODS: We selected 160 patients who were divided into 3 groups according to the distance between anastomosis and dentate line (A: 0-1.0 cm, B: 1.0-2.0 cm, C: 2.0-3.0 cm), who received evaluation with Wexner scoring systems at 3 months and at 1 year after operation, using FIQL questionnaire for quality of life and anus-rectal vectorial manometry 1 year after operation. The normal controls were 30 healthy people without anus-rectal disease and disordered defecation.
RESULTS: Lower anastomosis level meant higher Wexner scores (10.1 vs 6.1 vs 4.1, P < 0.05) at 3 mo after operation. After 1 year of adaptation and functional exercise, the scores of three groups decreased obviously (10.1 vs 5.7, 6.1 vs 3.1, 6.1 vs2.9, all P < 0.05). However, compared with B group and C group, A group still had significantly higher scores (5.7 vs 3.1, 2.9,P < 0.05), but no differences were detected between B group and C group. As for quality of life satisfaction, three groups of patients showed no significant differences in life-style, psychological coping/behavior, depression/self-feelings and embarrassing 1 year after operation.
CONCLUSION: For the low anterior resection of rectal cancer surgery, the lower of the position of anastomosis, the worse of the function and the quality of life. For the distance between stoma and dentate line less than 1 cm, the long-term survival quality of life has also declined markedly.
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Ayaz S, Kubilay G. Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma. J Clin Nurs 2009; 18:89-98. [DOI: 10.1111/j.1365-2702.2008.02282.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Böhm G, Kirschner-Hermanns R, Decius A, Heussen N, Schumpelick V, Willis S. Anorectal, bladder, and sexual function in females following colorectal surgery for carcinoma. Int J Colorectal Dis 2008; 23:893-900. [PMID: 18535831 DOI: 10.1007/s00384-008-0498-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to establish the incidence of potential postoperative anorectal, bladder, and sexual dysfunction in women following excision of rectal cancer with total mesorectal excision (TME). MATERIALS AND METHODS All women who underwent a transabdominal rectal resection with TME for cancer between 2000 and 2003 were included. Women with a colonic resection for cancer during the same time period served as the control group. Exclusion criteria were strict. Standardized questionnaires were sent to all patients. RESULTS Twenty-six patients fulfilled the inclusion criteria and were evaluated. Fifteen patients had TME and 11 patients had colonic resection. The median Wexner score showed a higher rate of anal incontinence in the rectal group. The difference was due to a higher rate of severe incontinence in the rectal group. The King's Health Questionnaire showed normal urinary function in both groups. The Female Sexual Function Index showed worse sexual function in the rectal group, reaching statistical significance in the categories 'arousal' and 'lubrication'. CONCLUSION After rectal excision, the women showed impairment of their anorectal and sexual function. Urinary function was normal. This is in contrast to the incidence of urinary dysfunction in men observed by others. Our study indicates that women seem to have less functional problems when compared to literature data on dysfunction in male following rectal surgery for cancer.
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Affiliation(s)
- G Böhm
- Department of General and Visceral Surgery, Universitätsklinikum Aachen, Aachen, Germany.
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The Effect of Colorectal Surgery in Female Sexual Function, Body Image, Self-Esteem and General Health: A Prospective Study. Ann Surg 2008; 248:266-72. [DOI: 10.1097/sla.0b013e3181820cf4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Murata A, Brown CJ, Raval M, Phang PT. Impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer. Am J Surg 2008; 195:611-5; discussion 615. [DOI: 10.1016/j.amjsurg.2007.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 12/17/2007] [Accepted: 12/17/2007] [Indexed: 11/26/2022]
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Rectal augmentation: short- and mid-term evaluation of a novel procedure for severe fecal urgency with associated incontinence. Ann Surg 2008; 247:421-7. [PMID: 18376184 DOI: 10.1097/sla.0b013e31815f9885] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Rectal augmentation (RA) with or without electrically stimulated gracilis neosphincter (ESGN) was developed to address the physiologic and anatomic abnormalities present in a subset of patients with incapacitating fecal urgency and associated urge fecal incontinence (UFI). This study evaluated the short- and medium-term clinical and physiologic results. METHODS Eleven patients with fecal urgency and UFI underwent RA, 6 with concomitant ESGN formation. Patients were evaluated preoperatively, and at a median of 12.5 and 54 months after surgery. RESULTS At 4.5 years, 7/11 patients had avoided stoma construction. Symptoms recurred leading to permanent stoma formation in 1 patient, whereas one other developed evacuatory difficulty with overflow incontinence. Median ability to defer defecation improved from seconds preoperatively to 10 minutes at 1 year (P = 0.0002), and 15 minutes at 4.5 years (P = 0.002). Median Wexner incontinence scores improved from 15 preoperatively to 3 at 1 year (P = 0.002), and 4 at 4.5 years (P = 0.02). At 1 year, 2 of the rectal sensory thresholds (DDV: P = 0.008; MTV: P = 0.008) and compliance were normalized (P = 0.008), whereas at 4.5 years, all sensation thresholds improved (FCS: P = 0.002; DDV: P = 0.002; MTV: P = 0.002), but changes in compliance were not significant. CONCLUSION RA with or without ESGN improved reported symptoms and normalized rectal sensation. Improvements were sustained in the medium term. The procedure had no associated morbidity or mortality, and should be considered in the surgical management of a select group of patients presenting with severe urgency and UFI.
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Raina R, Pahlajani G, Khan S, Gupta S, Agarwal A, Zippe CD. Female sexual dysfunction: classification, pathophysiology, and management. Fertil Steril 2007; 88:1273-84. [PMID: 17991514 DOI: 10.1016/j.fertnstert.2007.09.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 09/10/2007] [Indexed: 01/23/2023]
Abstract
Female sexual dysfunction is a prevalent problem in the general community; however, it has not been studied as extensively as male sexual dysfunction. Female sexual dysfunction is a common complication after most pelvic surgeries. With the introduction of screening programs, most pelvic malignancies are detected at earlier stages and in younger patients. Sexual dysfunction is a major quality-of-life issue in these young women. Hysterectomy (simple or radical) is the most common type of pelvic surgery in women and is one of the most important causes of female sexual dysfunction. Additionally, female sexual dysfunction is an important issue after urologic (radical cystectomy) and colorectal surgeries (simple and radical proctocolectomy). Sexual dysfunction is a common problem among postmenopausal women. Modifications in the surgical technique (nerve sparing) are rapidly evolving in the field of urology and colorectal surgery, which will be soon followed by modifications in the field of gynecologic surgery. In this article we summarize the pathophysiology and classification of female sexual dysfunction, with special emphasis on the relationship between female sexual dysfunction and pelvic surgeries.
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Affiliation(s)
- Rupesh Raina
- Glickman Urological Institute and Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Cancer Survivorship Issues in Colorectal Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Coco C, Valentini V, Manno A, Rizzo G, Gambacorta MA, Mattana C, Verbo A, Picciocchi A. Functional results after radiochemotherapy and total mesorectal excision for rectal cancer. Int J Colorectal Dis 2007; 22:903-10. [PMID: 17294197 DOI: 10.1007/s00384-007-0276-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to prospectively define and measure evacuation and continence disorders after preoperative radiochemotherapy and total mesorectal excision (TME) for rectal cancer 1 year after surgery. MATERIALS AND METHODS We submitted 100 patients, who underwent neoadjuvant treatment and anterior resection with TME from 1996 to 2003, to a questionnaire on postoperative continence and evacuation. Anal sphincter function was further assessed by the Memorial Sloan-Kettering score. Factors influencing anorectal function were examined in univariate and multivariate analysis. RESULTS Median evacuation score was 16.12 +/- 5.12 (range 0-28). Sensation of incomplete evacuation was reported in 58% of cases, necessity to return to the bathroom <15 min in 37% and inability to evacuate completely <15 min in 35%. Median continence score was 13.7 +/- 4.79 (range 0-20). Incontinence to flatus was reported in 46% of cases. Colonic J-pouch allows better evacuation and continence. Continence was also better in absence of postoperative complications. Sphincter function resulted excellent or good in 75% of patients according to the Memorial Sloan-Kettering score. CONCLUSIONS The most frequent symptoms in our series are the sensation of incomplete evacuation, the incontinence to flatus, and the necessity to return to the bathroom <15 min. Colonic J-pouch warrants a better function. Postoperative complications compromise good functional results.
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Affiliation(s)
- C Coco
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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Tomita R, Igarashi S, Ikeda T, Koshinaga T, Fujisaki S, Tanjoh K. Pudendal Nerve Terminal Motor Latency in Patients With or Without Soiling 5 Years or more after Low Anterior Resection for Lower Rectal Cancer. World J Surg 2006; 31:403-8. [PMID: 17180566 DOI: 10.1007/s00268-006-0149-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND To clarify the neurological function with respect to external anal sphincter (EAS) muscles in patients with or without soiling after low anterior resection (LAR) for lower rectal cancer, we examined the terminal motor latency in the pudendal motor nerves (PNTML). MATERIALS AND METHODS Thirty-eight patients after LAR for lower rectal cancer were studied electrophysiologically and compared with 30 healthy volunteers as controls (19 men and 11 women, aged 44 to 76 years of age, with a mean age of 65.5 years). Patients after LAR were divided into two groups [18 patients with soiling (12 men and 6 women, aged 51 to 77 years with a mean age of 64.8 years), 20 patients without soiling (13 men and 7 women, aged 47 to 75 years with a mean age of 62.1 years)]. The mean follow-up time from LAR was 67.2 months (range 60-84 months). Bilateral (left-sided and right-sided) PNTML tests were performed on all patients in order to measure the latency of the response in the bilateral EAS muscle following digitally directed transrectal pudendal nerve stimulation. RESULTS The distance from the anal verge to the level of anastomosis in patients with soiling (mean, 2.2 cm) was significantly shorter than that in patients without soiling (mean, 4.1 cm) (P < 0.05). Conduction delay of the bilateral PNTML in patients with soiling was longer than that in patients without soiling and normal subjects, significantly (P < 0.01, respectively). There was no significant difference between the right-sided and left-sided PNTML. CONCLUSIONS These findings support the hypothesis that soiling after LAR may be partially caused by damage to the bilateral pudendal motor nerves.
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Affiliation(s)
- Ryouichi Tomita
- Department of Surgery, Nippon Dental University School of Dentistry at Tokyo, 2-3-16 Fujimi Chiyoda-ku, Tokyo, 102-8158, Japan.
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Pollack J, Holm T, Cedermark B, Altman D, Holmström B, Glimelius B, Mellgren A. Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 2006; 93:1519-25. [PMID: 17054311 DOI: 10.1002/bjs.5525] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Preoperative radiotherapy improves local control and survival in rectal cancer, but there are few reports on long-term morbidity. The aims of this study were to compare long-term morbidity and quality of life in patients undergoing rectal cancer surgery with or without preoperative radiotherapy.
Methods
A total of 252 patients, randomized within the two Stockholm trials on preoperative radiotherapy in rectal cancer, were alive at a mean of 15 years after surgery. Some 139 of these patients were available for follow-up by questionnaires and clinical examination. Questionnaires regarding medical history and quality of life were completed by all patients. All patients had a clinical examination, and those without a stoma underwent rigid sigmoidoscopy.
Results
Overall, patients who had preoperative radiotherapy experienced significantly more late complications than those who did not (69 versus 43 per cent; P = 0·002). This morbidity consisted mainly of cardiovascular disease (35 versus 19 per cent; P = 0·032), faecal incontinence (12 of 21 versus 11 of 42 patients having anterior resection; P = 0·013) and urinary incontinence (45 versus 27 per cent; P = 0·023). No significant differences between groups were found for hip or pelvic fractures, small bowel obstruction or global quality of life.
Conclusion
Preoperative short-course, high-dose radiotherapy in patients with rectal cancer increases the risk of anal and urinary dysfunction, and may lead to increased cardiovascular morbidity, at long-term follow-up.
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Affiliation(s)
- J Pollack
- Karolinska Institute Divisions of Surgery at Danderyd Hospital, Sweden
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Abstract
The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and N0), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Information concerning the depth of tumor penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1N0M0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended. In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases, preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered, including: (1) total mesorectal excision (TME); (2) autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin; (5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7) postoperative quality of life.
© 2006 The WJG Press. All rights reserved.
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Affiliation(s)
- Glen-C Balch
- Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-1077, New York, NY 10021, USA
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Salonia A, Briganti A, Dehò F, Zanni G, Rigatti P, Montorsi F. Women's sexual dysfunction: a review of the "surgical landscape". Eur Urol 2006; 50:44-52. [PMID: 16650925 DOI: 10.1016/j.eururo.2006.03.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 03/22/2006] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To assess the impact of urogynaecologic surgery for stress urinary incontinence, oncologic pelvic surgery, and hysterectomy on women's overall sexual health. METHODS We used Ovid and PubMed (updated January 2006) to conduct a literature electronic search on MEDLINE that included peer-reviewed English-language articles. We analysed all studies identified that provided any functional outcome data about urogynaecologic surgery for the treatment of stress urinary incontinence, radical cystectomy for bladder cancer, surgery for rectal cancer, and hysterectomy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data. RESULTS Most studies showed that either urogynaecologic or oncologic pelvic surgery may have a significant impact on women's sexual health. Epidemiology varied widely among the studies and reported either improvement or impairment of postoperative sexual functioning, due to different definitions, study designs, and small cohorts of patients. An increasing number of studies have prospectively examined this issue and have found often controversial findings about the role of pelvic and perineal surgery in women's sexual health. CONCLUSIONS Although numerous controversies exist, data demonstrate an overall positive impact of the surgical repair for stress urinary incontinence on resolution of coital incontinence, coupled with an improvement of overall sexual life. In contrast, genitourinary and rectal cancers are commonly associated with treatment-related sexual dysfunction, but few studies rigorously assessed women's postoperative sexual function after major oncologic pelvic surgery. Data about the functional outcome after hysterectomy are often contradictory. Adequately powered prospective clinical trials are needed.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy.
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Schmidt CE, Bestmann B, Küchler T, Kremer B. Factors influencing sexual function in patients with rectal cancer. Int J Impot Res 2005; 17:231-8. [PMID: 15716980 DOI: 10.1038/sj.ijir.3901276] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Only few studies have investigated the impact of surgery for rectal cancer on sexual function. Little of that research included quality of life (QoL) aspects and hardly any study analyzed the impact of age, gender and type of surgery on sexual function. The aim of the presented study was to address these issues. Over a 5 y period, EORTC-QLQ-C-30 and a tumor-specific module were prospectively administered to patients before surgery, at discharge, 3, 6, 12 and 24 months postoperatively. Comparisons were made between patients receiving abdominoperineal resection (APR), anterior resection (AR) with or without Pouch and Sigmoid resection. Furthermore, effects of surgery on female and male patients, and age groups were analyzed. A total of 819 patients participated in the study: 412 were males and 407 were females. The groups were comparable in terms of adjuvant treatment, tumor stage and histology. Patients after APR and AR with Pouch had worst sexual function. Men reported significantly more difficulties with sexual enjoyment; furthermore, over time, sexual problems created high levels of strain in men that were worse than baseline levels in the early postoperative period. These problems tended to remain. Patients aged 69 y and younger scored higher for problems with loss of sexual function and sexuality-related strain than patients aged 70 y and older. The findings in this study confirm that QoL changes postsurgery and that factors like type of surgery, gender and age have tremendous impact on sexual function and sexual enjoyment. APR and AR with Pouch affect sexual function more than AR and resection of the lower sigmoid. Through impaired sexual enjoyment, men are put more under strain than women. Patients aged 69 y and younger experience more stress through deteriorated sexual function.
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Affiliation(s)
- C E Schmidt
- Department of General and Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Hendren SK, O'Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005; 242:212-23. [PMID: 16041212 PMCID: PMC1357727 DOI: 10.1097/01.sla.0000171299.43954.ce] [Citation(s) in RCA: 427] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To measure sexual function and quality of life (QOL) after rectal cancer treatment. SUMMARY BACKGROUND DATA Previous studies on sexual function after rectal cancer treatment have focused on males and have not used validated instruments. METHODS Patients undergoing curative rectal cancer surgery from 1980 to 2003 were administered a questionnaire, including the Female Sexual Function Index (FSFI) or International Index of Erectile Function (IIEF), and the EORTC QLQ-C30/CR-38. Multiple logistic regression was used to test associations of clinical factors with outcomes. RESULTS Eighty-one women (81.0%) and 99 men (80.5%) returned the questionnaire; 32% of women and 50% of men are sexually active, compared with 61% and 91% preoperatively (P < 0.04); 29% of women and 45% of men reported that "surgery made their sexual lives worse." Mean (SD) FSFI and IIEF scores were 17.5 (11.9) and 29.3 (22.8). Specific sexual problems in women were libido 41%, arousal 29%, lubrication 56%, orgasm 35%, and dyspareunia 46%, and in men libido 47%, impotence 32%, partial impotence 52%, orgasm 41%, and ejaculation 43%. Both genders reported a negative body image. Patients seldom remembered discussing sexual risks preoperatively and seldom were treated for dysfunction. Current age (P < 0.001), surgical procedure (P = 0.003), and preoperative sexual activity (P = 0.001) were independently associated with current sexual activity. Gender (male, P = 0.014), surgical procedure (P = 0.005), and radiation therapy (P = 0.0001) were independently associated with the outcome "surgery made sexual life worse." Global QOL scores were high. CONCLUSIONS Sexual problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. Therefore, sexual dysfunction should be discussed with rectal cancer patients, and efforts to prevent and treat it should be increased.
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Gladman MA, Williams NS, Scott SM, Ogunbiyi OA, Lunniss PJ. Medium-term results of vertical reduction rectoplasty and sigmoid colectomy for idiopathic megarectum. Br J Surg 2005; 92:624-30. [PMID: 15810056 DOI: 10.1002/bjs.4918] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Vertical reduction rectoplasty (VRR) was devised specifically to address the physiological abnormalities present in the rectum of patients with idiopathic megarectum (IMR). This study evaluated the medium-term clinical and physiological results of VRR.
Methods
VRR and sigmoid colectomy was performed in ten patients with IMR and constipation (six women). Patients were evaluated before and a median of 60 (range 28–74) months after surgery by assessment of symptoms using scoring systems and anorectal physiological measurements. Independent, detailed postoperative evaluation of rectal diameter, compliance, and sensory and evacuatory function was performed.
Results
There were no deaths or late complications. Symptoms recurred necessitating permanent ileostomy formation in two patients. Median (range) constipation scores improved from 22 (18–27) before to 10 (0–24) after surgery (P = 0·016). Median (range) bowel frequency increased from 1·5 (0·2–7) to 7 (0·5–21) per week (P = 0·016). Rectal diameter, compliance and sensory function were normal in seven of eight patients after surgery. Evacuatory function and colonic transit were each normalized in two of eight patients after VRR.
Conclusion
VRR corrected rectal diameter, compliance and sensory function in most patients, and clinical benefit was sustained in the medium term. The procedure was associated with a low morbidity, and no mortality and should be considered in the surgical management of IMR.
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Affiliation(s)
- M A Gladman
- Centre for Academic Surgery (Gastrointestinal Physiology Unit), St Bartholomew's and The Royal London Hospital, Queen Mary's School of Medicine and Dentistry, Whitechapel, London, UK
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Schmidt CE, Bestmann B, Küchler T, Longo WE, Kremer B. Ten-year historic cohort of quality of life and sexuality in patients with rectal cancer. Dis Colon Rectum 2005; 48:483-92. [PMID: 15747079 DOI: 10.1007/s10350-004-0822-6] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE In various studies, type of surgery, age, and gender had different impact on sexuality and quality of life in patients with rectal cancer. This study was designed to investigate how sexuality and quality of life are affected by age, gender, and type of surgery. METHODS A total of 516 patients who had undergone surgery for rectal cancer in our department from 1992 to 2002 were included. Within one year after the operation, 117 patients died. Questionnaires were sent to 373 patients 12 to 18 months after surgery. We received quality of life data from 261 patients. Comparisons were made after adjusting age, gender, and type of surgical procedure. RESULTS For patients receiving abdominoperineal resection sexuality was most impaired. Significant differences were seen in symptom and function scales between males and females. Females reported more distress from the medical treatment insomnia, fatigue, and constipation. Both genders had impaired sexual life; however, males had significantly higher values and felt more distressed by this impairment. Younger females felt more distress through impaired sexuality. In males sexuality was impaired independent of age. Adjuvant therapy had no influence on sexuality but on quality of life one year after surgery. CONCLUSIONS Assessing quality of life with general and specific instruments is helpful to determine whether patients improved through the treatment. The study showed that gender, age, and type of surgery influence sexuality and that quality of life after surgery for rectal cancer is impacted. Because quality of life is a predictor for complications and survival, availability of such data may help to direct supportive treatment to improve outcome.
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Affiliation(s)
- Christian E Schmidt
- Department of General and Thoracic Surgery, University of Kiel, Kiel, Germany.
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Nappi R, Salonia A, Traish AM, van Lunsen RHW, Vardi Y, Kodiglu A, Goldstein I. ORIGINAL RESEARCH—PATHOPHYSIOLOGY: Clinical Biologic Pathophysiologies of Women's Sexual Dysfunction. J Sex Med 2005; 2:4-25. [PMID: 16422901 DOI: 10.1111/j.1743-6109.2005.20102.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Data concerning the biologic pathophysiology of desire, arousal, and orgasm in women are limited. AIM To gain knowledge of biologic pathophysiology of female sexual function. METHODS. To provide state-of-the-art knowledge concerning female sexual dysfunction, representing the opinions of seven experts from five countries developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURE An International Consultation in alliance with key urological and sexual medicine societies convened over 200 multidisciplinary specialists from 60 countries into 17 consultation committees. The aims, goals and intentions of each committee were defined. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee dialogue, open presentation, and debate. RESULTS Three critical physiologic requirements, including intact sex steroids, autonomic/somatic nerves, and arterial inflow/perfusion pressure to women's genital organs play fundamental roles in maintaining women's sexual function. Despite this, there are nominal data supporting a direct pathophysiologic involvement of abnormal sex steroid values, and/or damage/injury to neurologic and/or blood flow integrity in women with problems in sexual desire, arousal, and/or orgasm. This summary details the available literature concerning hormonal, neurologic, and vascular organic pathophysiologies of women's sexual dysfunctions. CONCLUSIONS Additional research on clinical pathophysiologies in women's sexual dysfunction is needed. This chapter encompasses data presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28-July 1, 2003.
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Abstract
Rectal cancer is a major health concern in the United States, with an estimated 40,570 new cases diagnosed in 2004. There are 4 major goals in the treatment of a patient with rectal cancer: local control; long-term survival; preservation of anal sphincter, bladder, and sexual function; and maintenance or improvement in quality of life. Recent advances have been made in preoperative staging, local and radical surgical therapy, the importance of distal and circumferential resection margins, postoperative preservation of the anal sphincter mechanism and genitourinary function, and the role of laparoscopy in the treatment of these patients. Our aim is to outline some of the important surgical issues surrounding the management of patients with early-stage (T1/T2 N0) or locally advanced (T3/T4 and/or N1) rectal cancer.
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Affiliation(s)
- David B Chessin
- Colorectal Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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45
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Salonia A, Munarriz RM, Naspro R, Nappi RE, Briganti A, Chionna R, Federghini F, Mirone V, Rigatti P, Goldstein I, Montorsi F. Women's sexual dysfunction: a pathophysiological review. BJU Int 2004; 93:1156-64. [PMID: 15142131 DOI: 10.1111/j.1464-410x.2004.04796.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- A Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
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Tytherleigh MG, McC Mortensen NJ. Options for sphincter preservation in surgery for low rectal cancer. Br J Surg 2003; 90:922-33. [PMID: 12905543 DOI: 10.1002/bjs.4296] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Abdominoperineal excision of the rectum with a permanent end-sigmoid colostomy was the classical operation for cancer of the distal third of the rectum. A number of factors have recently led to a more conservative approach, allowing sphincter preservation when excising tumours that are not invading the anal sphincter. METHODS The review is based on the published literature of the treatment of low rectal cancers accessed by searching Medline and other online databases. It includes a description of all the surgical options currently available for low rectal tumours, and a discussion of the advantages and disadvantages of the types of anastomosis and reconstruction. RESULTS AND CONCLUSION It is now technically possible to remove rectal cancer that is extending into the anal canal with preservation of the anal sphincter mechanism and with a satisfactory oncological outcome. Ultra-low colorectal and coloanal anastomosis, together with a colonic pouch or coloplasty, produces acceptable function in many patients. However, there is still controversy about the risk of tumour implantation, the place of downsizing neoadjuvant therapy, and true long-term functional outcome. Despite these concerns, surgeons should strive to perform rectal resection with sphincter preservation for low-lying rectal cancer whenever possible.
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Affiliation(s)
- M G Tytherleigh
- Department of Colorectal Surgery, John Radcliffe Hospital, Oxford OX3 9DZ, UK.
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