Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer

Dan Asplund, Mattias Prytz, David Bock, Eva Haglind, Eva Angenete, Dan Asplund, Mattias Prytz, David Bock, Eva Haglind, Eva Angenete

Abstract

Purpose: Short-term complications related to the perineal wound after abdominoperineal excision (APE) are a well-known problem. Perineal morbidity in the longer term is an almost unexplored area. The aim of this cross-sectional study was to investigate the prevalence of perineal symptoms 3 years after APE for rectal cancer, to identify potential risk factors and to explore the relationship between perineal morbidity and global quality of life.

Method: All patients who underwent APE in Sweden between 2007 and 2009 (n = 1373) were identified through the Swedish Colorectal Cancer Registry. Surviving patients were contacted 3 years after surgery and asked about participation. A total of 545 patients completed a detailed questionnaire. Clinical data was collected from the registry and surgical charts.

Results: Perineal symptoms occurred in 50 % of all patients 3 years after APE and more frequently in women (58 vs. 44 %; p = 0.001). Delayed healing of the perineal wound (>4 weeks) occurred in 25 % of all patients and more frequently after extralevator APE (ELAPE) than after conventional APE (32 vs. 11 %, p < 0.001). Delayed healing was associated with an increased risk of more severe perineal symptoms (relative risk (RR) 1.50, 95 % confidence interval (95 % CI) 1.09-2.05). Patients with more severe perineal symptoms (n = 129) had a significantly lower global quality of life as measured by EQ-5D visual analogue scale (VAS; median 75 vs. 83 points on the 100-point scale; p < 0.001).

Conclusion: Persistent perineal symptoms are common after APE and may have an impact on patients' quality of life. Delayed wound healing may be a risk factor for persistent symptoms. Further studies are needed to identify avoidable clinical factors for the development of persistent perineal morbidity. CLINICALTRIALS.

Gov identifier: NCT01296984.

Keywords: Abdominoperineal excision; Perineal morbidity; Quality of life; Rectal cancer.

Figures

Fig. 1
Fig. 1
Development of a study-specific questionnaire
Fig. 2
Fig. 2
Flowchart of patients

References

    1. Angenete E, Correa-Marinez A, Heath J, et al. Ostomy function after abdominoperineal resection—a clinical and patient evaluation. Int J Colorectal Dis. 2012;27:1267–1274. doi: 10.1007/s00384-012-1463-1.
    1. Asplund D, Haglind E, Angenete E. Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre. Colorectal Dis. 2012;14:1191–1196. doi: 10.1111/j.1463-1318.2012.02930.x.
    1. Asplund D, Heath J, Gonzalez E, et al. Self-reported quality of life and functional outcome in patients with rectal cancer—QoLiRECT. Dan Med J. 2014;61:A4841.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Greenland S. Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case–control studies. Am J Epidemiol. 2004;160:301–305. doi: 10.1093/aje/kwh221.
    1. Ho VP, Lee Y, Stein SL, et al. Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum. 2011;54:113–125. doi: 10.1007/DCR.0b013e3181fb7b82.
    1. Holm T, Ljung A, Häggmark T, et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg. 2007;94:232–238. doi: 10.1002/bjs.5489.
    1. Jorgren F, Johansson R, Damber L, et al. Validity of the Swedish Rectal Cancer Registry for patients treated with major abdominal surgery between 1995 and 1997. Acta Oncol. 2013;52:1707–1714. doi: 10.3109/0284186X.2013.805886.
    1. Kasparek MS, Hassan I, Cima RR, et al. Long-term quality of life and sexual and urinary function after abdominoperineal resection for distal rectal cancer. Dis Colon Rectum. 2012;55:147–154. doi: 10.1097/DCR.0b013e31823d2606.
    1. Kreicbergs U, Valdimarsdottir U, Onelov E, et al. Talking about death with children who have severe malignant disease. N Engl J Med. 2004;351:1175–1186. doi: 10.1056/NEJMoa040366.
    1. Musters GD, Sloothaak DA, Roodbeen S, et al. Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment. Int J Colorectal Dis. 2014;29:1151–1157. doi: 10.1007/s00384-014-1967-y.
    1. Omerov P, Steineck G, Runeson B, et al. Preparatory studies to a population-based survey of suicide-bereaved parents in Sweden. Crisis. 2013;34:200–210. doi: 10.1027/0227-5910/a000175.
    1. Ortiz H, Ciga MA, Armendariz P, et al. Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer. Br J Surg. 2014;101:874–882. doi: 10.1002/bjs.9522.
    1. Pachler J, Wille-Jorgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev. 2012;12:CD004323.
    1. Pahlman L, Bohe M, Cedermark B, et al. The Swedish rectal cancer registry. Br J Surg. 2007;94:1285–1292. doi: 10.1002/bjs.5679.
    1. Pickard AS, Neary MP, Cella D. Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes. 2007;5:70. doi: 10.1186/1477-7525-5-70.
    1. Prytz M, Angenete E, Bock D et al. (2015) Extralevator Abdominoperineal Excision for Low Rectal Cancer-Extensive Surgery to be Used With Discretion Based on 3-Year Local Recurrence Results: A Registry-based, Observational National Cohort Study. Annals of surgery
    1. Prytz M, Angenete E, Ekelund J, et al. Extralevator abdominoperineal excision (ELAPE) for rectal cancer-short-term results from the Swedish Colorectal Cancer Registry. Selective use of ELAPE warranted. Int J Colorectal Dis. 2014;29:981–987. doi: 10.1007/s00384-014-1932-9.
    1. Prytz M, Angenete E, Haglind E. Abdominoperineal extralevator resection. Dan Med J. 2012;59:A4366.
    1. Rabin R, De Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–343. doi: 10.3109/07853890109002087.
    1. Steineck G, Bergmark K, Henningsohn L. Symptom documentation in cancer survivors as a basis for therapy modifications. Acta Oncol. 2002;41:244–252. doi: 10.1080/02841860260088782.
    1. Steineck G, Helgesen F, Adolfsson J, et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002;347:790–796. doi: 10.1056/NEJMoa021483.
    1. Welsch T, Mategakis V, Contin P, et al. Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications. Int J Colorectal Dis. 2013;28:503–510. doi: 10.1007/s00384-012-1611-7.
    1. West N, Anderin C, Smith K, et al. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010;97:588–599. doi: 10.1002/bjs.6916.
    1. West NP, Finan PJ, Anderin C, et al. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol. 2008;26:3517–3522. doi: 10.1200/JCO.2007.14.5961.
    1. Yu HC, Peng H, He XS, et al. Comparison of short- and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2014;29:183–191. doi: 10.1007/s00384-013-1793-7.
    1. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–706. doi: 10.1093/aje/kwh090.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir