Physical Performance and Quality of Life After Extended Abdominoperineal Excision of Rectum and Reconstruction of the Pelvic Floor With Gluteus Maximus Flap

Abstract

This study aimed to evaluate the physical performance and quality of life after an extended abdominoperineal excision of the rectum and the reconstruction with a right-sided unilateral gluteus myocutaneus rotation flap in patients with rectal and anal cancer. Nineteen patients with primary or recurrent rectal or anal cancer were investigated a mean of 26 months (range, 10-39 mo) after the operation. All patients received preoperative radiation therapy. Physical performance, hip movability, balance, and ability to sit were measured according to a prospective protocol, and the patients' perception of pain and quality of life were investigated with questionnaires. Postoperative complications and oncological results were registered retrospectively from patient records of 36 patients who had undergone operations. The timed-stands test showed that 12 of 19 patients performed worse than the upper limit of reference values adjusted for age and gender. The Berg balance scale showed a mean score of 52.8 that is close to the maximum score (56) of the test. The mean calculated EQ-5D (EuroQol Group, Rotterdam, The Netherlands) quality-of-life index was 0.71 based on the 5 questions in the instrument. The ability to sit 10 minutes was reduced in 4 patients, and 8 patients used a cushion or ring. Mean pain score was 20 (visual analog scale from 0 to 100) while sitting, and only 9 of 19 patients were pain free. The hip mobility was normal, but 6 patients had reduced flexion strength on the right side compared with the left side. Twenty-eight of 36 patients (78%) had some kind of early or late complication after surgery. Local recurrence was found in 4 of 36 patients (11%). The oncological outcome of the operation was acceptable, but functional drawbacks must be considered preoperatively in counseling the patient. More research is needed to find ways to preserve better function and well-being.