Is my life going to change?—a review of quality of life after rectal resection

Abstract

Rectal resection is a common practice for colorectal surgeons. The causes of this procedure are varied. The most frequent is cancer, but also inflammatory bowel disease, endometriosis, and rectovaginal or rectourethral fistulas. The loss of the normal rectal reservoir function, urinary problems, sexual dysfunction or pelvic pain are frequently reported in patients after rectal surgery and these disorders markedly affect the overall quality of life (QoL). In the last decades, rectal surgery has radically changed, with the development of surgical techniques, and it has progressed from abdominoperineal resection (APR) with a permanent colostomy to sphincter-saving procedures. Nowadays, the use of sphincter-preserving surgery has increased, but all these surgical techniques can have important sequels that modify the QoL of the patients. Historically, surgical outcomes, such as complications, survival and recurrences, have been widely studied by surgeons. In the present day, surgical outcomes have improved, rectal cancer recurrence rate has decreased and survival has increased. For these reasons, it has begun to gain importance in aspects of the QoL of patients, such as body image, fecal continence and sexuality or urinary function. Therefore, physicians should know the influence of different techniques and approaches on functional outcomes and QoL, to be able to inform patients of the treatment benefits and risk of postoperative dysfunctions. The aim of our study is to review the current literature to determine to what degree the QoL of patients who underwent a rectal resection decreases, which domains are the most affected and, in addition, to establish the influence of different surgical techniques and approaches on functional outcomes.

Understanding the psychosocial impact of colorectal cancer on young‐onset patients: A scoping review

“…While there is growing literature on the psychosocial impact of young‐onset cancer, prior work focused on cancer diagnosis in general and did not delve adequately into the unique challenges of specific types of cancer. For CRC in particular, patients may experience sexual dysfunction, urinary problems and loss of normal bowel function after undergoing rectal resection 12 . Some patients may also require an ostomy, a surgically created opening to allow discharge of waste from body, which can negatively impact body image 13 .…”

“…For CRC in particular, patients may experience sexual dysfunction, urinary problems and loss of normal bowel function after undergoing rectal resection. 12 Some patients may also require an ostomy, a surgically created opening to allow discharge of waste from body, which can negatively impact body image. 13 Given that the incidence of young‐onset CRC continues to rise worldwide, there is a need to better understand the psychosocial impact of this specific disease in younger adults.…”

Discussion of QOL (with Concise Summary of Newer Clinical Research) in Colorectal Cancer Patients Treated in a Retrospective Trial on the Effect of Surgical Resection Margins on Survival, with Relation to Operation Type

“…This may offer hope for functional outcomes of lower tumours, which are otherwise operable only with APR (29). Some studies have, however reported an increase postoperative anorectal disfunction, when combined with PCRT (30). Another confounding factor, could be the surgical donuts themselves, as a negative stapler donut does not preclude involvement of the distal margin, as it contains only a part of a staple or suture line.…”

Rectal Cancer: Open Questions in 2022 Current Standards of Clinical Practice and Ongoing Trials

“…With a worldwide perspective, the incidence and mortality rates of rectal cancer do not correlate but seem to depend on the availability of centers with high-volume expertise and a multidisciplinary team of clinicians guiding the course of treatment. In experienced centers, superior outcomes can be achieved shifting the focus of interdisciplinary treatment efforts toward quality-of-life and functional outcomes [3].…”