Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): A long-term prospective, multicentre, cohort study

Kang, Sung Bum; Cho, Jung Rae; Jeong, Seung‐Yong; Oh, Jae Hwan; Ahn, Soyeon; Choi, Sunkyu; Kim, Duck-Woo; Lee, Bong Hwa; Youk, Eui Gon; Park, Sung Chan; Heo, Seung Chul; Lee, Doo‐Seok; Ryoo, Sungwoo; Park, Ji Won; Park, Hyoung-Chul; Lee, Sung-Min; Kim, Min Hyun; Oh, Heung‐Kwon; Shin, Rumi; Kim, Min Jung; Lee, Kyung Ho; Kim, Young-Hoon; Kim, Jae-Sung; Lee, Keun-Wook; Lee, Hye Seung; Kim, Hyun Jung; Park, Young Soo; Sohn, Dae Kyung; Park, Kyu Joo

doi:10.1016/j.lanwpc.2020.100087

Cited by 31 publications

(31 citation statements)

References 33 publications

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“…1 This multimodality treatment, although effective in achieving tumor control, is associated with significant morbidity, with bowel, urinary, and sexual dysfunction that can impair patients' quality of life permanently. 2 In addition, many patients with distal rectal cancer are left with a permanent colostomy. 2 As most of the sequelae from the multimodality therapy are related to surgery, 3 there is a strong incentive to explore nonsurgical treatment options.…”

Section: Introductionmentioning

confidence: 99%

Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy

García-Aguilar

Patil

Gollub

et al. 2022

JCO

474

316

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PURPOSE Prospective data on the efficacy of a watch-and-wait strategy to achieve organ preservation in patients with locally advanced rectal cancer treated with total neoadjuvant therapy are limited. METHODS In this prospective, randomized phase II trial, we assessed the outcomes of 324 patients with stage II or III rectal adenocarcinoma treated with induction chemotherapy followed by chemoradiotherapy (INCT-CRT) or chemoradiotherapy followed by consolidation chemotherapy (CRT-CNCT) and either total mesorectal excision (TME) or watch-and-wait on the basis of tumor response. Patients in both groups received 4 months of infusional fluorouracil-leucovorin-oxaliplatin or capecitabine-oxaliplatin and 5,000 to 5,600 cGy of radiation combined with either continuous infusion fluorouracil or capecitabine during radiotherapy. The trial was designed as two stand-alone studies with disease-free survival (DFS) as the primary end point for both groups, with a comparison to a null hypothesis on the basis of historical data. The secondary end point was TME-free survival. RESULTS Median follow-up was 3 years. Three-year DFS was 76% (95% CI, 69 to 84) for the INCT-CRT group and 76% (95% CI, 69 to 83) for the CRT-CNCT group, in line with the 3-year DFS rate (75%) observed historically. Three-year TME-free survival was 41% (95% CI, 33 to 50) in the INCT-CRT group and 53% (95% CI, 45 to 62) in the CRT-CNCT group. No differences were found between groups in local recurrence-free survival, distant metastasis-free survival, or overall survival. Patients who underwent TME after restaging and patients who underwent TME after regrowth had similar DFS rates. CONCLUSION Organ preservation is achievable in half of the patients with rectal cancer treated with total neoadjuvant therapy, without an apparent detriment in survival, compared with historical controls treated with chemoradiotherapy, TME, and postoperative chemotherapy.

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Section: Introductionmentioning

confidence: 99%

Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy

García-Aguilar

Patil

Gollub

et al. 2022

JCO

474

316

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“…For patients with low-lying rectal cancer, those who underwent APR had better social and cognitive function and less symptoms compared with SPS group in a prospective study 46 . In a newest RCT study, different result was found as SPS showed better sexual-urinary functions in male patients 47 . According to the long-term QoL analysis in this study, although SPS patients had higher body image score, cognitive and social function are not satisfactory and LARS related symptoms such as diarrhoea and constipation are prominent.…”

Section: Discussionmentioning

confidence: 98%

Prognosis and Quality of Life Analysis After Neoadjuvant Chemoradiotherapy and Primary Surgery for Low-lying Locally Advanced Rectal Cancer: Can Patients Benefit From Neoadjuvant Therapy?

Guo

Peng

et al. 2021

Preprint

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BackgroundNeoadjuvant Chemoradiotherapy (nCRT) is a widely accepted regimen for patients with locally advanced rectal cancer (LARC). This compared the long-term prognosis and postoperative quality of life (QoL) between patients with low-lying LARC receiving nCRT and primary surgery.MethodPatients underwent nCRT or primary surgery for low-lying LARC between 2010 and 2016 were identified. Five-year local recurrence (LR) and disease free survival (DFS) were compared between groups. Quality of life (QoL) of patients who were disease-free was investigated using European Organization for Research and Treatment of Cancer QoL questionnaire core-30 (EORTC QLQ-C30) and QLQ-Colorectal Cancer module (CR29).ResultsA total of 304 patients were included in this study. Differences in 5-year LR and DFS between groups showed no statistical significance. In terms of QoL, apart from less stoma care problem, nCRT patients showed unsatisfactory social function and worse symptoms including diarrhoea, financial difficulties, buttock pain, fecal incontinence, embarrassment and impotence compared with primary surgery group. Intergroup analysis indicated that the QoL of patients receiving nCRT with preserved sphincter was relatively inferior compared with other subgroups, as reflected in higher symptom scores including financial difficulties and those related to low anterior resection syndrome (LARS) such as diarrhea, stool frequency, flatulence and fecal incontinence.ConclusionFor patients with low-lying LARC, nCRT has no advantage in terms of 5-year survival and QoL. NCRT with sphincter preserving surgery should be conducted meticulously considering its limited benefits for patients.

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“…These subsequent studies may therefore be more relevant to current practice. Another study 49 published since completion of the search also identified no difference in global QoL; however, although patients who had undergone APE had lower preoperative QoL, this was not accounted for in the conclusion that patients should undergo restorative surgery for low rectal cancer.…”

Section: Discussionmentioning

confidence: 98%

Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review

et al. 2021

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Background Low rectal cancers could be treated using restorative (anterior resection, AR) or non-restorative procedures with an end/permanent stoma (Hartmann’s, HE; or abdominoperineal excision, APE). Although the surgical choice is determined by tumour and patient factors, quality of life (QoL) will also influence the patient's future beyond cancer. This systematic review of the literature compared postoperative QoL between the restorative and non-restorative techniques using validated measurement tools. Methods The review was registered on PROSPERO (CRD42020131492). Embase and MEDLINE, along with grey literature and trials websites, were searched comprehensively for papers published since 2012. Inclusion criteria were original research in an adult population with rectal cancer that reported QoL using a validated tool, including the European Organization for Research and Treatment of Cancer QLQ-CR30, QLQ-CR29, and QLQ-CR38. Studies were included if they compared AR with APE (or HE), independent of study design. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Outcomes of interest were: QoL, pain, gastrointestinal (GI) symptoms (stool frequency, flatulence, diarrhoea and constipation), and body image. Results Nineteen studies met the inclusion criteria with a total of 6453 patients; all papers were observational and just four included preoperative evaluations. There was no identifiable difference in global QoL and pain between the two surgical techniques. Reported results regarding GI symptoms and body image documented similar findings. The ROBINS-I tool highlighted a significant risk of bias across the studies. Conclusion Currently, it is not possible to draw a firm conclusion on postoperative QoL, pain, GI symptoms, and body image following restorative or non-restorative surgery. The included studies were generally of poor quality, lacked preoperative evaluations, and showed considerable bias in the data.

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Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): A long-term prospective, multicentre, cohort study

Cited by 31 publications

References 33 publications

Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy

Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy

Prognosis and Quality of Life Analysis After Neoadjuvant Chemoradiotherapy and Primary Surgery for Low-lying Locally Advanced Rectal Cancer: Can Patients Benefit From Neoadjuvant Therapy?

Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review

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