Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer

Table 1 Sociodemographic and clinicopathologic data of the patients n (%)

	Laparoscopic group	Open group	P value
Number of patients	49	25	/
Age (yr, mean ± SD)	65.6 ± 11.3	66.7 ± 12.4	0.7051
Sex (male/female)	30/19	15/10	0.9192
Body mass index (kg/m2, mean ± SD)	22.4 ± 3.4	21.4 ± 3.5	0.2101
Number of patients with comorbidities	27 (55.1)	13 (52)	0.8002
Marital status (married/divorced/widow/single)	36/5/6/2	18/3/4/0	0.7422
Education level (under primary/primary/secondary/tertiary or above)	10/19/16/4	8/10/6/1	0.6232
Tumor location in rectum (upper/middle/lower)	26/15/8	12/10/3	0.6972
Types of surgery (AR/LAR with TME)	24/25	12/13	0.9362
Number of patients with temporary ileostomy	25 (51)	13 (52)	0.9362
Number of patients with complications	17 (34.7)	13 (52)	0.1522
Subclinical anastomotic leak	0	1
Anastomotic bleeding	1	0
Chest infection	1	3
Wound infection	2	5
Urinary tract infection	2	5
Urinary retention	4	5
Prolonged ileus	7	3
Others	1	3
Reoperation	0	0
AJCC staging (I/II/III)	3/26/20	2/13/10	0.9552
Adjuvant chemotherapy	20 (40.8)	10 (40)	0.9462
Adjuvant radiotherapy	11 (22.4)	7 (28)	0.5992

¹Student’s t test;

²χ² test. AR: Anterior resection; LAR: Low anterior resection; TME: Total mesorectal excision; AJCC: American Joint Committee on Cancer.

Table 2 Comparison of European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 scores between the laparoscopic and open groups at different time points

	Baseline			4 mo			8 mo			12 mo
	Lap	Open	P value	Lap	Open	P value	Lap	Open	P value	Lap	Open	P value
EORTC QLQ-C30
Functional scales
Global QoL	72.4 (3.4)	68.3 (5.2)	0.443	65.8 (3.6)	47.3 (5.9)	0.009	73.6 (3.8)	52.0 (5.9)	0.003	71.1 (3.4)	61.0 (7.0)	0.371
Physical	94.7 (1.3)	91.5 (2.6)	0.255	86.4 (2.3)	77.6 (4.1)	0.056	89.9 (1.4)	79.2 (3.7)	0.016	87.1 (2.6)	81.3 (4.0)	0.149
Role	88.8 (3.0)	92.7 (3.1)	0.660	75.9 (4.5)	67.3 (6.6)	0.155	85.0 (3.4)	63.3 (6.9)	0.005	82.7 (3.9)	71.3 (7.1)	0.129
Emotional	71.1 (4.1)	66.0 (5.4)	0.404	76.0 (4.0)	82.0 (4.9)	0.401	79.8 (3.4)	71.3 (6.3)	0.379	79.1 (3.2)	71.0 (6.3)	0.579
Cognitive	71.1 (4.2)	66.7 (5.5)	0.415	67.7 (3.6)	59.3 (5.8)	0.284	73.5 (3.4)	50.7 (6.2)	0.002	61.9 (4.2)	60.0 (6.7)	0.940
Social	82.7 (3.2)	88.0 (4.4)	0.292	73.5 (3.1)	64.7 (5.7)	0.268	76.9 (3.8)	62.7 (7.1)	0.110	76.5 (4.0)	62.7 (7.4)	0.124
Symptom scales/items
Fatigue	16.6 (2.8)	14.2 (2.9)	0.859	17.7 (2.6)	27.6 (4.3)	0.042	13.8 (2.7)	28.9 (5.9)	0.027	12.0 (2.2)	15.6 (4.0)	0.520
Nausea/vomiting	0 (0)	0.7 (0.7)	0.162	3.1 (1.3)	6.7 (3.7)	0.931	0 (0)	2.7 (2.1)	0.046	0 (0)	1.3 (1.3)	0.162
Pain	14.3 (3.2)	16.7 (4.5)	0.772	20.1 (2.7)	25.3 (5.2)	0.534	16.7 (2.7)	27.3 (5.2)	0.089	15.6 (2.9)	19.3 (5.4)	0.755
Dyspnea	4.1 (1.6)	2.7 (1.8)	0.581	7.5 (2.2)	16 (5.5)	0.208	2.7 (1.3)	12 (6.0)	0.252	4.1 (2.1)	12.0 (5.0)	0.065
Insomnia	33.3 (5.1)	58.7 (8.5)	0.011	32.0 (5.1)	46.7 (8.2)	0.141	27.2 (4.8)	45.3 (7.9)	0.052	30.6 (5.1)	46.7 (8.4)	0.129
Appetite loss	8.8 (2.7)	6.7 (4.3)	0.313	7.5 (2.2)	14.7 (6.4)	0.794	6.8 (2.2)	17.3 (4.8)	0.035	7.5 (3.0)	10.7 (4.2)	0.330
Constipation	18.4 (4.6)	29.3 (8.0)	0.292	11.6 (4.2)	12.0 (4.7)	0.525	15.0 (4.4)	6.7 (2.7)	0.508	18.4 (4.5)	10.7 (5.3)	0.205
Diarrhea	19.7 (4.4)	17.3 (6.1)	0.759	23.1 (4.9)	30.7 (7.2)	0.394	15.0 (4.2)	29.3 (8.2)	0.156	15.0 (4.1)	21.3 (6.6)	0.379
Financial difficulties	13.6 (4.0)	14.7 (4.7)	0.426	24.5 (4.3)	37.3 (6.5)	0.066	23.1 (5.2)	42.7 (7.1)	0.010	13.6 (3.6)	20.0 (6.7)	0.580
EORTC QLQ-CR38
Functional scales
Body image	93.9 (1.9)	93.3 (2.6)	0.945	81.0 (4.2)	82.7 (6.0)	0.699	81.2 (3.9)	85.3 (4.8)	0.834	87.8 (3.7)	84.4 (5.6)	0.526
Sexual functioning	18.7 (3.9)	14.0 (5.3)	0.268	18.7 (4.1)	8.7 (5.1)	0.069	19.0 (4.2)	16.0 (5.7)	0.630	19.0 (4.3)	17.3 (5.7)	0.807
Future perspective	54.4 (4.9)	64.0 (7.2)	0.272	54.4 (4.4)	45.3 (6.0)	0.309	44.2 (5.1)	42.7 (7.8)	0.779	44.2 (4.9)	44.0 (6.9)	0.995
Symptom scales/items
Micturition problems	37.8 (4.4)	38.7 (6.9)	0.907	32.3 (4.7)	54.7 (7.1)	0.011	22.8 (4.0)	40.7 (6.9)	0.020	31.6 (4.5)	41.3 (6.9)	0.246
Chemotherapy side effects1	16.7 (4.1)	10.0 (2.6)	0.530	41.1 (7.3)	44.4 (11.1)	0.846	20.6 (4.7)	28.9 (7.8)	0.422	8.9 (3.3)	17.8 (6.0)	0.214
Gastrointestinal tract symptoms	20.7 (2.2)	19.5 (2.8)	0.817	16.6 (1.9)	18.1 (2.8)	0.656	15.9 (1.9)	24.8 (3.3)	0.022	18.0 (2.2)	16.3 (3.3)	0.546
Defecation problems2	22.2 (2.3)	15.5 (3.5)	0.133	24.3 (3.6)	21.4 (3.0)	0.821	11.8 (2.5)	23.0 (4.9)	0.062	13.2 (2.9)	16.3 (3.3)	0.235
Weight loss	27.9 (4.7)	38.7 (8.3)	0.376	8.8 (3.2)	24.0 (7.6)	0.079	6.1 (2.1)	17.3 (6.1)	0.094	6.1 (2.1)	10.7 (4.2)	0.383

¹Only for patients who received chemotherapy, 20 in the laparoscopic group and 10 in the open group;

²Only for patients without temporary loop ileostomy, 24 in the laparoscopic group and 12 in the open group. Quality of life (QoL) scores are presented as the mean (standard error of mean). Scores ranged from 0 to 100. A higher score on a functional scale indicates better functioning, whereas a higher score on a symptom scale indicates a higher degree of symptoms. Scores in the laparoscopic and open groups were compared by the Mann-Whitney U test. EORTC: European Organization for Research and Treatment of Cancer.

Table 3 Sexual enjoyment and sexual problems among men who have been sexually active: Laparoscopic vs open groups

	Baseline			4 mo			8 mo			12 mo
	Lap	Open	P value	Lap	Open	P value	Lap	Open	P value	Lap	Open	P value
Number of men who have been sexually active	14	5	/	6	1	/	10	5	/	12	5	/
Sexual enjoyment (functional scale)	40.5 (8.0)	20.0 (8.2)	0.164	38.9 (18.1)	33.3 (/)	1.000	46.7 (7.4)	6.7 (6.7)	0.004	44.4 (10.3)	0 (0.0)	0.019
Male sexual problems (symptom scale)	16.7 (8.4)	0 (0)	0.194	33.3 (13.6)	66.7 (/)	0.309	20.0 (8.5)	76.7 (14.5)	0.013	29.2 (11.3)	80.0 (9.7)	0.026

Quality of life scores are presented as the mean (standard error of mean). Scores ranged from 0 to 100. A higher score on a functional scale indicates better functioning, whereas a higher score on a symptom scale indicates a higher degree of symptoms. Scores in the laparoscopic and open groups were compared by the Mann-Whitney U test.