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.	丛进春, 张宏, 陈春生, 等.生物反馈训练可以提高超低位直肠癌内括约肌切除术后的排便功能[J].世界华人消化杂志, 2006, 14(25):2566-2570.
5.	丛进春, 戴显伟, 张宏, 等.低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究[J].中国普外基础与临床杂志, 2007, 14(6):634-638.
6.	丛进春, 戴显伟, 张宏, 等.超低位直肠癌经括约肌间切除术后的肛门功能评价[J].中国现代医学杂志, 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.	汪晓东, 曹霖, 曾天芳, 等.多学科协作诊治模式下新辅助化疗对直肠癌术后近期并发症影响的临床对照研究[J].中国普外基础与临床杂志, 2008, 15(4):289-294, 302.
21.	汪晓东, 吕东昊, 宋欢, 等.多模式术前评估系统对中低位直肠癌手术方案选择的价值:一项随机对照试验[J].中国普外基础与临床杂志, 2009, 16(6):487-492.
22.	汪晓东, 赖玮婧, 肖凌, 等.多学科协作诊治模式下不同直肠癌手术方案联合新辅助化疗的临床疗效[J].中国普外基础与临床杂志, 2008, 15(11):855-860.
23.	汪晓东, 曹霖, 罗德云, 等.多学科协作诊治模式下运行结直肠癌综合治疗的临床对照研究[J].中国普外基础与临床杂志, 2008, 15(1):63-66.
24.	汪晓东, 李亚伦, 邱萌, 等.多学科协作诊治模式下新辅助化疗对直肠癌手术的影响[J].中国普外基础与临床杂志, 2008, 15(2):136-139.
25.	汪晓东, 邱萌, 李亚伦, 等.多学科协作诊治模式下结直肠癌不同周期新辅助化疗联合手术的方案研究[J].中国普外基础与临床杂志, 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. 丛进春, 张宏, 陈春生, 等.生物反馈训练可以提高超低位直肠癌内括约肌切除术后的排便功能[J].世界华人消化杂志, 2006, 14(25):2566-2570.
5. 丛进春, 戴显伟, 张宏, 等.低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究[J].中国普外基础与临床杂志, 2007, 14(6):634-638.
6. 丛进春, 戴显伟, 张宏, 等.超低位直肠癌经括约肌间切除术后的肛门功能评价[J].中国现代医学杂志, 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. 汪晓东, 曹霖, 曾天芳, 等.多学科协作诊治模式下新辅助化疗对直肠癌术后近期并发症影响的临床对照研究[J].中国普外基础与临床杂志, 2008, 15(4):289-294, 302.
21. 汪晓东, 吕东昊, 宋欢, 等.多模式术前评估系统对中低位直肠癌手术方案选择的价值:一项随机对照试验[J].中国普外基础与临床杂志, 2009, 16(6):487-492.
22. 汪晓东, 赖玮婧, 肖凌, 等.多学科协作诊治模式下不同直肠癌手术方案联合新辅助化疗的临床疗效[J].中国普外基础与临床杂志, 2008, 15(11):855-860.
23. 汪晓东, 曹霖, 罗德云, 等.多学科协作诊治模式下运行结直肠癌综合治疗的临床对照研究[J].中国普外基础与临床杂志, 2008, 15(1):63-66.
24. 汪晓东, 李亚伦, 邱萌, 等.多学科协作诊治模式下新辅助化疗对直肠癌手术的影响[J].中国普外基础与临床杂志, 2008, 15(2):136-139.
25. 汪晓东, 邱萌, 李亚伦, 等.多学科协作诊治模式下结直肠癌不同周期新辅助化疗联合手术的方案研究[J].中国普外基础与临床杂志, 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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