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Does Extended Surgery Influence Health-Related Quality of Life in Patients With Rectal Cancer?

Orsini, Ricardo G. M.D.1; Vermeer, Thomas A. M.D.1; Traa, Marjan J. M.Sc., Ph.D.2; Nieuwenhuijzen, Grard A. P. M.D., Ph.D.1; de Hingh, Ignace H. J. T. M.D., Ph.D.1; Rutten, Harm J. T. M.D., Ph.D.1,3

doi: 10.1097/DCR.0000000000000292
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: In locally advanced rectal cancer, an extended resection peripheral to the mesorectal fascia is needed to achieve a radical resection. The influence of extended resections on health-related quality of life is unclear.

OBJECTIVE: Differences in health-related quality of life and sexuality between patients receiving standard surgery and patients receiving extended surgery were examined, with a focus on age.

DESIGN: Patients operated on for rectal cancer between 2000 and 2010 were selected from a database and invited to complete the European Organization for Research and Treatment of Cancer quality-of-life questionnaires (C30 and ColoRectal 38).

SETTINGS: All patients were treated at the Catharina Hospital, Eindhoven, the Netherlands.

PATIENTS: All patients received total mesorectal excision surgery or extended surgery for rectal cancer.

MAIN OUTCOME MEASURES: Health-related quality of life and sexual activity was compared between patients treated with total mesorectal excision surgery and extended surgery and further stratified by age at the time of surgery (<70 and ≥70).

RESULTS: Two hundred twenty-nine (64.1%) patients with standard surgery and 128 (35.9%) patients treated with extended resections responded. Extended surgery in patients <70 years resulted in lower body image compared with patients <70 years receiving standard surgery. Patients ≥70 years had lower sexual function and more male sexual dysfunction than patients <70 years undergoing standard surgery. In all groups, sexual activity dropped significantly after treatment.

LIMITATIONS: No information was available of the patients' health-related quality of life before treatment except for the retrospective question about sexual activity.

CONCLUSIONS: This study showed no major differences between patients undergoing total mesorectal excision surgery and those receiving extended surgery, with the exception of body image, which was significantly lower in patients <70 years undergoing extended surgery. In all patient groups, treatment for rectal cancer influenced sexual activity dramatically. Awareness of the impact of surgery on health-related quality of life and sexuality is needed.

1Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands

2CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands

3Research Institute Growth & Development, Maastricht University Medical Center, Maastricht, the Netherlands

Financial Disclosure: None reported.

Correspondence: Harm J. T. Rutten, M.D., Ph.D., F.R.C.S.(Lond.), Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, the Netherlands. E-mail:

© 2015 The American Society of Colon and Rectal Surgeons