Anorectal functional outcome following laparoscopic low anterior resection for rectal cancer

Abstract

Low anterior resection (LAR) with total mesorectal excision has been considered a standard treatment for patients with rectal cancer. However, the functional outcome and life quality of laparoscopic LAR (LLAR) in Chinese patients remain unclear. A cohort of 51 Chinese patients (22 men and 29 women) who had undergone LLAR was included in this study. Anorectal manometry combined with the Wexner scores questionnaire were applied to assess functional outcome preoperatively (1 week) and postoperatively (at 3, 6 and 9 months). The validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires were also used to assess the patients' quality of life at the indicated time points. The results demonstrated that the manometric parameters exhibited a temporary decrease at 3 months postoperatively, but a gradual increase at 6 and 9 months, while the Wexner scores exhibited an opposite trend. Furthermore, patients with high anastomoses had significantly higher manometric parameters, a lower frequency of incontinence and lower Wexner scores compared with those with low anastomoses at 9 months (all P<0.05). For the entire cohort, quality of life at 3 months postoperatively was worse compared with the preoperative level, but returned to normal by 9 months. Patients with high anastomoses exhibited significantly better role, emotional and social function, had a better body image and sexual function, fewer problems with defecation and lower frequency of diarrhea, as well as fewer chemotherapy-related side effects at 6 months postoperatively when compared with the low anastomosis group (all P<0.05). In conclusion, LLAR is generally acceptable for Chinese patients with rectal cancer, particularly for those with middle or high rectal cancer, in terms of functional outcome and quality of life.

Keywords: anorectal function; laparoscopic low anterior resection; manometry; rectal cancer.

Figure 1.

Anorectal manometry for anal functional assessment. (A) Mean anal resting pressure. (B) Maximal anal resting pressure. (C) Maximal squeeze pressure. (D) Initial sensory volume. (E) Strong sensory volume. (F) Maximal tolerable volume. Error bars indicate the standard error of the mean. *, statistically significant difference (P<0.05). HA, high anastomosis; LA, low anastomosis.

Figure 2.

Changes in rectoanal inhibitory reflex, anal sphincter, incontinence and Wexner score. (A) Rectoanal inhibitory reflex rate. (B) Internal anal sphincter. (C) External anal sphincter. (D) Gas incontinence rate. (E) Liquid incontinence rate. (F) Solid incontinence rate. (G) Wexner score. Error bars indicate the standard error of the mean. *, statistically significant difference (P<0.05). HA, high anastomosis; LA, low anastomosis.

Figure 3.

Longitudinal assessment of changes in QoL-C30 scores for various functioning scales. (A) Global QoL scores. (B) Physical scores. (C) Role scores. (D) Emotional scores. (E) Cognitive scores. (F) Social scores. Error bars indicate the standard error of the mean. *, statistically significant difference (P<0.05). HA, high anastomosis; LA, low anastomosis; QoL, quality of life.

Figure 4.

Longitudinal assessment of changes in QoL-C30 scores for various symptom scales. (A) Fatigue scores. (B) Nausea/vomiting scores. (C) Pain scores. (D) Dyspnea scores. (E) Insomnia scores. (F) Appetite loss scores. (G) Constipation scores. (H) Diarrhea scores. (I) Financial difficulties scores. *, statistically significant difference (P<0.05). HA, high anastomosis; LA, low anastomosis; QoL, quality of life.

Figure 5.

Longitudinal assessment of changes in QoL-CR38 scores for various functional and symptom scales. (A) Sexual functioning scores. (B) Body image scores. (C) Future perspective scores. (D) Micturition problems scores (E) Chemotherapy side effects scores. (F) Gastrointestinal tract symptoms scores. (G) Defecation problems scores. (H) Weight loss scores. *, statistically significant difference (P<0.05). HA, high anastomosis; LA, low anastomosis; QoL, quality of life.