Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2015; 7(12): 349-355
Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.349
Quality of life in rectal cancer surgery: What do the patient ask?
Giovanni D De Palma, Gaetano Luglio
Giovanni D De Palma, Center of Excellence for Technical Innovation in Surgery, Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, 80131 Naples, Italy
Gaetano Luglio, Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, 80131 Naples, Italy
Author contributions: De Palma GD and Luglio G were both responsible for the design, conception, drafting, and final approval of this paper.
Conflict-of-interest statement: None. Giovanni D De Palma and Gaetano Luglio have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Giovanni D De Palma, MD, Director of Center of Excellence for Technical Innovation in Surgery, Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, via Pansini 5, 80131 Naples, Italy. giovanni.depalma@unina.it
Telephone: +39-81-7462773 Fax: +39-81-7462752
Received: May 24, 2015
Peer-review started: May 25, 2015
First decision: August 16, 2015
Revised: September 13, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 27, 2015
Abstract

Rectal cancer surgery has dramatically changed with the introduction of the total mesorectal excision (TME), which has demonstrated to significantly reduce the risk of local recurrence. The combination of TME with radiochemotherapy has led to a reduction of local failure to less than 5%. On the other hand, surgery for rectal cancer is also impaired by the potential for a significant loss in quality of life. This is a new challenge surgeons should think about nowadays: If patients live more, they also want to live better. The fight against cancer cannot only be based on survival, recurrence rate and other oncological endpoints. Patients are also asking for a decent quality of life. Rectal cancer is probably a paradigmatic example: Its treatment is often associated with the loss or severe impairment of faecal function, alteration of body anatomy, urogenital problems and, sometimes, intractable pain. The evolution of laparoscopic colorectal surgery in the last decades is an important example, which emphasizes the importance that themes like scar, recovery, pain and quality of life might play for patients. The attention to quality of life from both patients and surgeons led to several surgical innovations in the treatment of rectal cancer: Sphincter saving procedures, reservoir techniques (pouch and coloplasty) to mitigate postoperative faecal disorders, nerve-sparing techniques to reduce the risk for sexual dysfunction. Even more conservative procedures have been proposed alternatively to the abdominal-perineal resection, like the local excisions or transanal endoscopic microsurgery, till the possibility of a wait and see approach in selected cases after radiation therapy.

Keywords: Quality of life, Rectal cancer, Laparoscopic surgery, Sphincter preservation, Nerve-sparing

Core tip: Survival and disease-free survival for patients affected by rectal cancer have overall increased, thanks to the advances in surgery, medical treatments, palliative care and multimodal strategies. This editorial will explore how the growing demand for a better quality of life has in someway favored the development of new practices and new techniques such as sphincter saving procedures, reservoir techniques, minimally invasive surgery, as long as local treatments or even the possibility of a wait and see approach in highly selected cases.