Comparison of Anal Function and Quality of Life Between Partial Longitudinal Resection of The Anorectum and Sphincter and Intersphincteric Resection for Very Low Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CONGJin-chun ,  CHENChun-sheng , MAMing-xing , XIAZhi-xiu , LIUDing-sheng

Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding?author：

CHENChun-sheng, Email: chenchunsheng@sj-hospital.org

Keywords：

Partial longitudinal resection of the anorectum and sphincter; Intersphincteric resection; Rectal cancer; Anal function; Quality of life

DOI：

10.7507/1007-9424.20140073

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare anal function and quality of life between partial longitudinal resection of the anorectum and sphincter (PLRAS) and intersphincteric resection (ISR) for rectal cancer. Methods Ninety-nine cases of very low rectal cancer were classified as PLRAS group (n=23) and ISR group (n=76) according to different surgical method. Anal function was assessed by Saito function questionnaire and the Wexner scale in 6, 12, and 24 months after operation. At the same time, quality of life was assessed by European Organization for research and treatment of cancer quality of life questionnaire CR29 (EORTC-QLQ-CR29). Results ①Anastomosis stenosis:compared with ISR group, the situation on anastomosis stenosis was worse in 6 months (P < 0.001) and 12 months (P=0.003) after operation, but didn't significantly differed in 24 months after operation (P=0.230).②Results of the Saito function questionnaire:compared with ISR group, there were higher incidence on stool fragmentation (P=0.016), dyschesia (P=0.008), and feces-flatus discrimination (P < 0.001) in PLRAS group in 6 months after operation, and the incidence of feces-flatus discrimination was still higher in 12 months (P=0.017), but there was no any significant difference in 24 months after operation (P > 0.05).③Results of Wexner scale:there were no statistical difference between the 2 groups at all recorded times (P > 0.05).④Results of EORTC-QLQ-CR29 questionnaire:in 6 months after operation, the scores of flatulence (P=0.003), faecal incontinence (P=0.043), and sexual interest in women (P=0.023) of PLARS group were lower than ISR group but higher in buttock pain (P=0.031) and dyspareunia (P=0.006). In 12 months after operation, the scores of flatulence (P=0.012) and sexual interest in women (P=0.017) were both lower than ISR group, but score of dyspareunia was higher (P=0.012). In 24 months after operation, there was no any significant difference (P > 0.05). Conclusions PLRAS surgery have worse situation of anastomosis stenosis and sexual function in women than ISR surgery before 12 months after operation, but have analogous effect in 24 months after operation.

Citation： CONGJin-chun, CHENChun-sheng, MAMing-xing, XIAZhi-xiu, LIUDing-sheng. Comparison of Anal Function and Quality of Life Between Partial Longitudinal Resection of The Anorectum and Sphincter and Intersphincteric Resection for Very Low Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 305-312. doi: 10.7507/1007-9424.20140073 Copy

1.	?Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal cancer tumors[J]. Br J Surg, 1994, 81(9):1376-1378.
2.	Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma[J]. J Am Coll Surg, 2007, 205(5):642-647.
3.	Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer[J]. Br J Surg, 2012, 99(5):603-612.
4.	叢進春, 張宏, 陳春生, 等.生物反饋訓練可以提高超低位直腸癌內括約肌切除術后的排便功能[J].世界華人消化雜志, 2006, 14(25):2566-2570.
5.	叢進春, 戴顯偉, 張宏, 等.低位直腸癌經內外括約肌間切除術后直腸肛管向量測壓的研究[J].中國普外基礎與臨床雜志, 2007, 14(6):634-638.
6.	叢進春, 戴顯偉, 張宏, 等.超低位直腸癌經括約肌間切除術后的肛門功能評價[J].中國現代醫學雜志, 2008, 18(6):795-798.
7.	Cong JC, Chen CS, Zhang H, et al. Partial longitudinal resection of the anorectum and sphincter for very low rectal adenocarcinoma:a surgical approach to avoid permanent colostomy[J]. Colorectal Dis, 2012, 14(6):697-704.
8.	Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer:an active approach to avoid a permanent colostomy[J]. Dis Colon Rectum, 2004, 47(4):459-466.
9.	Jorge JM, Wexner SD. Etiology and management of fecal incon-tinence[J]. Dis Colon Rectum, 1993, 36(1):77-97.
10.	Gujral S, Conroy T, Fleissner C, et al. Assessing quality of life in patients with colorectal cancer:an update of the EORTC quality of life questionnaire[J]. Eur J Cancer, 2007, 43(10):1564-1573.
11.	Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016):a multicentre, randomised trial[J]. Lancet, 2009, 373(9666):811-820.
12.	Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J]. N Engl J Med, 2006, 355(11):1114-1123.
13.	Zhengwei Y, Weilin W, Yuzuo B, et al. Long-term outcomes of individualized biofeedback training based on the underlying dysfunction for patients with imperforate anus[J]. J Pediatr Surg, 2005, 40(3):555-561.
14.	Hiranyakas A, Da Silva G, Denoya P, et al. Colorectal anastomotic stricture:is it associated with inadequate colonic mobilization?[J]. Tech Coloproctol, 2013, 17(4):371-375.
15.	Padilla GV, Grant MM, Lipsett J, et al. Health quality of life and colorectal cancer[J]. Cancer, 1992, 70(5 Suppl):1450-1456.
16.	Nishizawa Y, Fujii S, Saito N, et al. The association between anal function and neural degeneration after preoperative chemoradiotherapy followed by intersphincteric resection[J]. Dis Colon Rectum, 2011, 54(11):1423-1429.
17.	Haboubi NY, Schofield PF, Rowland PL. The light and electron microscopic features of early and late phase radiation-induced proctitis[J]. Am J Gastroenterol, 1988, 83(10):1140-1144.
18.	Fajardo LF. The unique physiology of endothelial cells and its implications in radiobiology[J]. Front Radiat Ther Oncol, 1989, 23:96-112.
19.	Arraras JI, Suárez J, Arias-de-la-Vega F, et al. Quality of life assessment by applying EORTC questionnaires to rectal cancer patients after surgery and neoadjuvant and adjuvant treatment[J]. Rev Esp Enferm Dig, 2013, 105(5):255-261.
20.	汪曉東, 曹霖, 曾天芳, 等.多學科協作診治模式下新輔助化療對直腸癌術后近期并發癥影響的臨床對照研究[J].中國普外基礎與臨床雜志, 2008, 15(4):289-294, 302.
21.	汪曉東, 呂東昊, 宋歡, 等.多模式術前評估系統對中低位直腸癌手術方案選擇的價值:一項隨機對照試驗[J].中國普外基礎與臨床雜志, 2009, 16(6):487-492.
22.	汪曉東, 賴瑋婧, 肖凌, 等.多學科協作診治模式下不同直腸癌手術方案聯合新輔助化療的臨床療效[J].中國普外基礎與臨床雜志, 2008, 15(11):855-860.
23.	汪曉東, 曹霖, 羅德云, 等.多學科協作診治模式下運行結直腸癌綜合治療的臨床對照研究[J].中國普外基礎與臨床雜志, 2008, 15(1):63-66.
24.	汪曉東, 李亞倫, 邱萌, 等.多學科協作診治模式下新輔助化療對直腸癌手術的影響[J].中國普外基礎與臨床雜志, 2008, 15(2):136-139.
25.	汪曉東, 邱萌, 李亞倫, 等.多學科協作診治模式下結直腸癌不同周期新輔助化療聯合手術的方案研究[J].中國普外基礎與臨床雜志, 2008, 15(3):210-214.

1. ?Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal cancer tumors[J]. Br J Surg, 1994, 81(9):1376-1378.
2. Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma[J]. J Am Coll Surg, 2007, 205(5):642-647.
3. Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer[J]. Br J Surg, 2012, 99(5):603-612.
4. 叢進春, 張宏, 陳春生, 等.生物反饋訓練可以提高超低位直腸癌內括約肌切除術后的排便功能[J].世界華人消化雜志, 2006, 14(25):2566-2570.
5. 叢進春, 戴顯偉, 張宏, 等.低位直腸癌經內外括約肌間切除術后直腸肛管向量測壓的研究[J].中國普外基礎與臨床雜志, 2007, 14(6):634-638.
6. 叢進春, 戴顯偉, 張宏, 等.超低位直腸癌經括約肌間切除術后的肛門功能評價[J].中國現代醫學雜志, 2008, 18(6):795-798.
7. Cong JC, Chen CS, Zhang H, et al. Partial longitudinal resection of the anorectum and sphincter for very low rectal adenocarcinoma:a surgical approach to avoid permanent colostomy[J]. Colorectal Dis, 2012, 14(6):697-704.
8. Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer:an active approach to avoid a permanent colostomy[J]. Dis Colon Rectum, 2004, 47(4):459-466.
9. Jorge JM, Wexner SD. Etiology and management of fecal incon-tinence[J]. Dis Colon Rectum, 1993, 36(1):77-97.
10. Gujral S, Conroy T, Fleissner C, et al. Assessing quality of life in patients with colorectal cancer:an update of the EORTC quality of life questionnaire[J]. Eur J Cancer, 2007, 43(10):1564-1573.
11. Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016):a multicentre, randomised trial[J]. Lancet, 2009, 373(9666):811-820.
12. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J]. N Engl J Med, 2006, 355(11):1114-1123.
13. Zhengwei Y, Weilin W, Yuzuo B, et al. Long-term outcomes of individualized biofeedback training based on the underlying dysfunction for patients with imperforate anus[J]. J Pediatr Surg, 2005, 40(3):555-561.
14. Hiranyakas A, Da Silva G, Denoya P, et al. Colorectal anastomotic stricture:is it associated with inadequate colonic mobilization?[J]. Tech Coloproctol, 2013, 17(4):371-375.
15. Padilla GV, Grant MM, Lipsett J, et al. Health quality of life and colorectal cancer[J]. Cancer, 1992, 70(5 Suppl):1450-1456.
16. Nishizawa Y, Fujii S, Saito N, et al. The association between anal function and neural degeneration after preoperative chemoradiotherapy followed by intersphincteric resection[J]. Dis Colon Rectum, 2011, 54(11):1423-1429.
17. Haboubi NY, Schofield PF, Rowland PL. The light and electron microscopic features of early and late phase radiation-induced proctitis[J]. Am J Gastroenterol, 1988, 83(10):1140-1144.
18. Fajardo LF. The unique physiology of endothelial cells and its implications in radiobiology[J]. Front Radiat Ther Oncol, 1989, 23:96-112.
19. Arraras JI, Suárez J, Arias-de-la-Vega F, et al. Quality of life assessment by applying EORTC questionnaires to rectal cancer patients after surgery and neoadjuvant and adjuvant treatment[J]. Rev Esp Enferm Dig, 2013, 105(5):255-261.
20. 汪曉東, 曹霖, 曾天芳, 等.多學科協作診治模式下新輔助化療對直腸癌術后近期并發癥影響的臨床對照研究[J].中國普外基礎與臨床雜志, 2008, 15(4):289-294, 302.
21. 汪曉東, 呂東昊, 宋歡, 等.多模式術前評估系統對中低位直腸癌手術方案選擇的價值:一項隨機對照試驗[J].中國普外基礎與臨床雜志, 2009, 16(6):487-492.
22. 汪曉東, 賴瑋婧, 肖凌, 等.多學科協作診治模式下不同直腸癌手術方案聯合新輔助化療的臨床療效[J].中國普外基礎與臨床雜志, 2008, 15(11):855-860.
23. 汪曉東, 曹霖, 羅德云, 等.多學科協作診治模式下運行結直腸癌綜合治療的臨床對照研究[J].中國普外基礎與臨床雜志, 2008, 15(1):63-66.
24. 汪曉東, 李亞倫, 邱萌, 等.多學科協作診治模式下新輔助化療對直腸癌手術的影響[J].中國普外基礎與臨床雜志, 2008, 15(2):136-139.
25. 汪曉東, 邱萌, 李亞倫, 等.多學科協作診治模式下結直腸癌不同周期新輔助化療聯合手術的方案研究[J].中國普外基礎與臨床雜志, 2008, 15(3):210-214.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Anal Function and Quality of Life Between Partial Longitudinal Resection of The Anorectum and Sphincter and Intersphincteric Resection for Very Low Rectal Cancer

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