Persistent Sitting and Walking Difficulties After Abdominoperineal Excision and Anterior Resection: Results From the Quality of Life in Rectal Cancer (QoLiRECT) Study.

Abstract

Background: The main surgical resection options in rectal cancer are anterior resection for tumors in the mid- or upper rectum and abdominoperineal excision for tumors in the lower rectum. A previous study showed long-term persistent perineal symptoms and sitting difficulties after abdominoperineal excision.

Objective: To examine the prevalence and extent of sitting and walking difficulties after abdominoperineal excision compared with anterior resection.

Design: An observational, prospective, longitudinal, multicenter, international study.

Settings: Data were collected from participants in the quality of life in rectal cancer study. Participants answered questionnaires about bodily functions, symptoms and quality of life at baseline and 1 and 2 years after diagnosis.

Patients: Patients with newly diagnosed rectal cancer regardless of stage were included. The study included 1024 patients, of whom 64% underwent anterior resection and 36% underwent abdominoperineal excision.

Main outcome measures: The primary objective was to estimate the prevalence and odds ratios of sitting or walking difficulties between the two surgical procedure groups: abdominoperineal excision and anterior resection.

Results: In the group of patients who underwent abdominoperineal excision, 29% had sitting difficulties after 2 years compared with 12% in the group who underwent anterior resection (OR 2.65, 95% CI 1.71-4.09, p < 0.0001). Walking difficulties after 2 years were reported by 35% after abdominoperineal excision compared with 24% after anterior resection (OR 1.50, 95% CI 1.02-2.22, p = 0.04).

Limitations: The observational nature of the study could be regarded as a limitation.

Conclusions: Abdominoperineal excision was associated with both sitting and walking difficulties among patients with rectal cancer at significantly higher rates compared with anterior resection. It is probable that attention from healthcare could improve the situation of the patients by enhanced rehabilitation. See Video Abstract.Registered with ClinicalTrials.gov (NCT01477229).