Clinical and Translational Oncology

, Volume 21, Issue 10, pp 1390–1397 | Cite as

Comparison of overall survival and quality of life between patients undergoing anal reconstruction and patients undergoing traditional lower abdominal stoma after radical resection

  • P. Du
  • S.-Y. Wang
  • P.-F. Zheng
  • J. Mao
  • H. Hu
  • Z.-B. ChengEmail author
Research Article



Miles procedure is often necessary for patients with low rectal carcinoma. However, this operation often affects the quality of life of patients, to evaluate the advantages of improved operation (anal reconstruction), the quality of life and survival between patients undergoing anal reconstruction and patients undergoing traditional lower abdominal stoma after radical resection were analyzed.


The clinical data of 43 patients with low situated rectal carcinoma were retrospectively analyzed. 23 patients with left lower abdominal stoma after radical resection (Miles procedure) were divided into group A, and 20 patients with reconstruction of the anus in situ after radical resection were in group B. All patients were investigated by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaire, the clinical data are recorded. Independent sample T test was used to analyze the difference in quality of life between group A and group B at 3, 6, and 12 months after surgery, and Kaplan–Meier was used to compare the difference in overall survival between group A and group B.


The results of T test showed that there were statistical significance in global health status and physical functioning between group A and group B at 3 and 6 months, but no statistical significance at 12 months (P = 0.024, P = 0.019, P = 0.115 for global health status; P = 0.004, P = 0.006, P = 0.065 for physical functioning, respectively). Emotional functioning and social functioning were also statistically significant between group A and group B at 3, 6, and 12 months (P = 0.041, P = 0.040, P = 0.034 for Emotional functioning; P = 0.020, P = 0.009, P = 0.032 for social functioning, respectively). This study also found that there was no statistical significance in body image and sexual functioning between group A and group B at 3 months, but there was statistical significance at 6 and 12 months(P = 0.098, P = 0.035, P = 0.045 for body image; P = 0.110, P = 0.048, P = 0.047 for sexual functioning, respectively). There were statistically significant about sexual enjoyment and defecation problems at 3, 6, and 12 months (P = 0.023, P = 0.028, P = 0.050 for sexual enjoyment; P = 0.013, P = 0.011, P = 0.050 for defecation problems, respectively).The results of Kaplan–Meier showed that the overall survival (OS) between group A and group B was not statistically significant (χ2 = 0.600, P = 0.439).


There was no difference in survival time between group A and group B, but compared with the patients with left lower abdominal stoma(group A), the quality of life was better in patients with reconstruction of the anus in situ (group B). It is significant to improve the traditional lower abdominal stoma operation.


EORTC QLQ-C30 EORTC QLQ-C38 Anal reconstruction Ostomy Rectal carcinoma 



This work was supported by grants from the scientific research project of Gansu health industry (No. GSWST2013-03).

Compliances with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest concerning this article.

Ethical approval

The study was approved by the Ethics Committee of the Second Hospital of Lanzhou University, and the data were anonymously obtained and retrospectively analyzed. The clinical data of all patients were collected from the electronic medical records of the Second Hospital of Lanzhou University. This study was performed in accordance with the relevant guidelines and regulations, and conformed to the Declaration of Helsinki.

Informed consent

Informed consents from participants were also waived due to the complete anonymity of the patients.


  1. 1.
    Schreckenbach T, Zeller MV, El Youzouri H, et al. Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: a single-center retrospective study[J]. J Geriatr Oncol. 2018;9:649–58.CrossRefPubMedGoogle Scholar
  2. 2.
    Simon K. Colorectal cancer development and advances in screening[J]. Clin Interv Aging. 2016;11:967–76.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Guo H, Zhou X, Lu Y, et al. Translational progress on tumor biomarkers[J]. Thorac Cancer. 2015;6(6):665–71.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mouchli MA, Ouk L, Scheitel MR, et al. Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer[J]. World J Gastroenterol. 2018;24(8):905–16.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Iwamoto M, Kawada K, Hida K, et al. Delayed anastomotic leakage following laparoscopic intersphincteric resection for lower rectal cancer: report of four cases and literature review[J]. World J Surg Oncol. 2017;15(1):143.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Zając O, Spychała A, Murawa D, et al. Quality of life assessment in patients with a stoma due to rectal cancer[J]. Rep Pract Oncol Radiother. 2008;13(3):130–4.CrossRefGoogle Scholar
  7. 7.
    Elfeki H, Thyo A, Nepogodiev D, et al. Patient and healthcare professional perceptions of colostomy-related problems and their impact on quality of life following rectal cancer surgery[J]. BJS Open. 2018;2(5):336–44.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jo S, Choi Y, Park SK, et al. Efficacy of dose-escalated radiotherapy for recurrent colorectal cancer[J]. Ann Coloproctol. 2016;32(2):66–72.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Methy N, Bedenne L, Bonnetain F. Surrogate endpoints for overall survival in digestive oncology trials: which candidates? A questionnaires survey among clinicians and methodologists[J]. BMC Cancer. 2010;10:277.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Du P, Xu B, Zhang D, et al. Hierarchical investigating the predictive value of p53, COX2, EGFR, nm23 in the post-operative patients with colorectal carcinoma[J]. Oncotarget. 2017;8(1):954–66.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim JW. The quality of life after rectal cancer surgery[J]. Korean J Gastroenterol. 2006;47(4):295–9.PubMedGoogle Scholar
  12. 12.
    Souza J, Nahas CSR, Nahas SC, et al. Health-related quality of life assessment in patients with rectal cancer treated with curative intent[J]. Arq Gastroenterol. 2018;55(2):154–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology[J]. J Natl Cancer Inst. 1993;85(5):365–76.CrossRefGoogle Scholar
  14. 14.
    Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR14). European Organization for Research and Treatment of Cancer Study Group on Quality of Life[J]. Eur J Cancer. 1999;35(2):238–47.CrossRefPubMedGoogle Scholar
  15. 15.
    Lin JK, Tan EC, Yang MC. Comparing the effectiveness of capecitabine versus 5-fluorouracil/leucovorin therapy for elderly Taiwanese stage III colorectal cancer patients based on quality-of-life measures (QLQ-C30 and QLQ-CR1) and a new cost assessment tool[J]. Health Qual Life Outcomes. 2015;13:61.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    World Medical A. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects[J]. Bull World Health Organ. 2001;79(4):373–4.Google Scholar
  17. 17.
    Kopp I, Bauhofer A, Koller M. Understanding quality of life in patients with colorectal cancer: comparison of data from a randomised controlled trial, a population based cohort study and the norm reference population[J]. Inflamm Res. 2004;53(Suppl 2):S130–5.PubMedGoogle Scholar
  18. 18.
    The World Cancer. Report—the major findings[J]. Cent. Eur J Public Health. 2003;11(3):177–9.Google Scholar
  19. 19.
    Reinwalds M, Blixter A, Carlsson E. A descriptive, qualitative study to assess patient experiences following stoma reversal after rectal cancer surgery[J]. Ostomy Wound Manag. 2017;63(12):29–37.Google Scholar
  20. 20.
    Nasvall P, Dahlstrand U, Lowenmark T, et al. Quality of life in patients with a permanent stoma after rectal cancer surgery[J]. Qual Life Res. 2017;26(1):55–64.CrossRefPubMedGoogle Scholar
  21. 21.
    Herrle F, Sandra-Petrescu F, Weiss C, et al. Quality of life and timing of stoma closure in patients with rectal cancer undergoing low anterior resection with diverting stoma: a multicenter longitudinal observational study[J]. Dis Colon Rectum. 2016;59(4):281–90.CrossRefPubMedGoogle Scholar
  22. 22.
    Segalla JG, Van Eyll B, Federico MH, et al. Evaluation of quality of life in patients with metastatic colorectal cancer treated with capecitabine[J]. Clin Colorectal Cancer. 2008;7(2):126–33.CrossRefPubMedGoogle Scholar
  23. 23.
    Pachler J, Wille-Jorgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy[J]. Cochrane Database Syst Rev. 2012;12:CD004323.PubMedGoogle Scholar
  24. 24.
    Neuman HB, Park J, Fuzesi S, et al. Rectal cancer patients’ quality of life with a temporary stoma: shifting perspectives[J]. Dis Colon Rectum. 2012;55(11):1117–24.CrossRefPubMedGoogle Scholar
  25. 25.
    Cakmak A, Aylaz G, Kuzu MA. Permanent stoma not only affects patients’ quality of life but also that of their spouses[J]. World J Surg. 2010;34(12):2872–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Sideris L, Zenasni F, Vernerey D, et al. Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics[J]. Dis Colon Rectum. 2005;48(12):2180–91.CrossRefPubMedGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.The Department of General SurgerySecond Hospital of Lanzhou UniversityLanzhouChina
  2. 2.Second Clinical Medical CollegeLanzhou UniversityLanzhouChina

Personalised recommendations