[Influence of adjuvant radio-chemotherapy for rectal cancer on quality of life]. / Einfluss der adjuvanten Radiochemotherapie beim Rektumkarzinom auf die Lebensqualität.

INTRODUCTION: Modern therapy for rectal cancer is associated with functional disorders. Dysfunction as a consequence of surgery has to be distinguished from disorders caused by postoperative therapy. Therefore we have compared the long-term functional results of patients who received postoperative radio-chemotherapy or no therapy in conjunction with low anterior resection of the rectum. PATIENTS AND METHOD: From 1997 to 2002, a total of 32 patients (16 males and 16 females) after low anterior rectal resection and postoperative radio-chemotherapy or surgical therapy alone was compared using standardized and validated instruments (Short-Form-36-Health-Survey, EORTC QLQ-C30, QLQ-CR 38 and ASCRS fecal incontinence questionnaire) in a matched-pair analysis (age, gender and time of surgery). Mean age was 61.8 (62.1) years and mean follow-up was 4 (3.8) years. RESULTS: Two out of the 40 examined parameters differed significantly. There were no significant differences in Short-Form-36-Health-Survey and EORTC QLQ-C30 scales between both groups. The QLQ-CR38 scale sexual enjoyment differed significantly, whereas future perspectives, sexual functioning, micturition problems, symptoms in the area of the gastrointestinal tract, weight loss, defecation problems, male and female sexual problems did not differ significantly. The scales Lifestyle, Coping/Behavior and Depression/Self-Perception of the ASCRS fecal incontinence questionnaire also did not differ significantly. The difference for embarrassment was significant. DISCUSSION: No differences in quality of life after postoperative radio-chemotherapy or no postoperative therapy in conjunction with low anterior rectal resection can be found. There are, however, tendencies that postoperative radio-chemotherapy has more adverse effects on continence and sexual function than low anterior rectal resection alone.

Laparoscopic TME: better vision, better results?

One of the most controversial discussions on laparoscopic surgery deals with the question of whether to apply this technique to malignant disease and specifically to rectal cancer. The four major issues are the adequacy of oncologic resection, recurrence rates and patterns, long-term survival and quality of life. There is evidence, from nonrandomized studies, suggesting that margins of excision and lymph node harvest achieved laparoscopically reached comparable results to those known from conventional open resection. Our own experience of laparoscopic surgery on rectal cancer is based on 52 patients treated with curative intent. Focusing on the postoperative long-term run, we gained the following results: The median age of patients was 66.7 years and ranged from 42-88. Anastomotic leakage was seen in 6.1% of cases. In a median follow-up of 48 months (36-136), we reached an overall 3-year survival rate of 93% and a 5-year survival rate of 62%. Local recurrence was 1.9%, distant metastasis occurred in 11.5% of cases. We saw no port-site metastasis. To evaluate functional results following laparoscopic surgery a matched pair analysis was carried out. Matching of patients after laparoscopic and conventional open surgery was performed according to sex, age, type of resection, time period of surgery, and stage of disease classified by UICC. Regarding bladder and sexual dysfunction, using the EORTC QLQ CR38 score we found no statistical significant difference between the examined groups. As far as can be seen, laparoscopic surgery in rectal carcinoma may achieve the same or, in selected patients, even better results than open surgery. However, at present no published study has shown much evidence. Many more studies are necessary to define the place of laparoscopic technique in rectal cancer surgery, regarding appropriate selection of patients and evaluating adjuvant or neoadjuvant treatment in combination with the laparoscopic approach.