Functional Outcomes in Rectal Cancer Patients After Surgical Treatment

Abstract

Functional outcomes are clinically important in the treatment of rectal cancer patients as they provide clinicians with important information to judge the patient’s status. Quality of life is based on the patient’s functional status; these two terms are often synonymous in healthcare. The function or quality of life is affected by rectal cancer itself and by its treatment. Clinicians must manage the patient’s quality of life and the patient’s concerns about disease symptoms and adverse effects. Because statistically significant differences in quality of life subscales may not be clinically important, it is critical to define what differences are clinically relevant. In addition, response shift phenomenon should be considered when interpreting quality of life in longitudinal studies. Although preoperative chemoradiotherapy has shifted the treatment paradigm toward organ preservation, its impact on quality of life is somewhat controversial when compared with no radiotherapy. Minimally invasive surgery may have clinical benefits on quality of life compared with open surgery, but no randomized controlled trials have demonstrated whether laparoscopic, robot-assisted, or transanal total mesorectal excision provides superior effects on quality of life. Sphincter-preserving surgery does not appear to be superior to a permanent stoma. Rectal cancer patients usually suffer from postoperative bowel dysfunction and sexual-urinary dysfunction, but we lack effective tools to preventive these dysfunctions. Therefore, patients should receive information about postoperative dysfunction before undergoing surgery. More work is needed to develop tools to prevent postoperative dysfunction related to rectal cancer treatment and to manage the quality of life of rectal cancer patients.