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. 2021 Nov 9;5(6):zrab101.
doi: 10.1093/bjsopen/zrab101.

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

Samuel Lawday  1   2   3 , Nicholas Flamey  1 , George E Fowler  1   2 , Matthew Leaning  1 , Nadine Dyar  1 , Ian R Daniels  1 , Neil J Smart  1   3 , Christopher Hyde  3
Affiliations

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

Samuel Lawday et al. BJS Open. .

Abstract

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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Figures

Fig. 1
Fig. 1
PRISMA diagram showing selection of articles for review QoL, quality of life.
Fig. 2
Fig. 2
Risk-of-bias assessment a Risk of bias in individual trials. D1, bias due to confounding; D2, bias due to selection of participants; D3, bias in classification of interventions; D4, bias due to deviations from intended interventions; D5, bias due to missing data; D6, bias in measurement of outcomes; D7, bias in selection of reported result. b Risk-of-bias summary.
See this image and copyright information in PMC

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