Effect of Surgery on Health-Related Quality of Life of Patients With Locally Recurrent Rectal Cancer

Abstract

Background: Local recurrences of rectal cancer are best treated with surgical resection. Health-related quality of life is an important outcome measure in rectal cancer, but it has been poorly investigated in local recurrences.

Objective: The purpose of this study was to assess quality of life in patients receiving or not receiving surgery for locally recurrent rectal cancer.

Design: This was a prospective cohort study.

Settings: The study was conducted at a single tertiary care institution.

Patients: Patients presenting with local recurrent rectal cancer between December 2002 and December 2011 were included. A control group of patients with nonrecurrent rectal cancer was prospectively enrolled (planned ratio, 1:2).

Main outcome measures: All of the patients received the core Quality of Life Questionnaire C30 of the European Organisation for Research and Treatment of Cancer preoperatively or at diagnosis and then 1 and 3 years later. We compared results according to oncologic clearance (R0 vs R1 vs R2 vs no surgery). Confounding variables were tested with a multivariate logistic regression.

Results: Forty-five patients (27 men), median age 62 years (range, 34-80 years), with recurrence were observed. Twelve (26.7%) were not fit for surgery. Twenty one (63.6%), 7 (21.2%), and 5 (15.2%) received R0, R1, and R2 resections. Data for 30 (90.9%) and 25 operated patients (75.75%) were available at 1- and 3-year follow-ups. Irrespective of type of surgery and multimodal treatments, patients receiving R0/R1 resections had improvement in quality of life in all of the domains compared with the R2 and no-surgery groups. Outcomes were inferior compared with nonrecurrent control subjects (N = 71). At 3 years, R0 patients reported scores equal to those of control subjects, with superior emotional functioning. R1 patients had worse symptoms and quality of life at 3-year follow-up. Surgery impaired survival and quality of life of R2 patients compared with those who were not operated on.

Limitations: The study was limited because it involved a single center with a single senior surgeon.

Conclusions: Quality of life of patients with locally recurrent rectal cancer is improved by R0 and ameliorated with R1 resection, irrespective of surgical extent. Full recovery, similar to that of nonrecurrent cancer survivors, can be expected in R0 patients but requires longer follow-up times. Surgery with macroscopic involvement of resection margins accelerates quality of life decline and shortens survival.