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Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3568–3576 | Cite as

Quality of Life After Total Mesorectal Excision and Rectal Replacement: Comparing Side-to-End, Colon J-Pouch and Straight Colorectal Reconstruction in a Randomized, Phase III Trial (SAKK 40/04)

  • Karin RibiEmail author
  • Walter R. Marti
  • Jürg Bernhard
  • Felix Grieder
  • Michael Graf
  • Beat Gloor
  • Gaudenz Curti
  • Markus Zuber
  • Nicolas Demartines
  • Christiane Andrieu
  • Martin Bigler
  • Stefanie Hayoz
  • Heinz Wehrli
  • Christoph Kettelhack
  • Bruno Lerf
  • Fabrizio Fasolini
  • Christian Hamel
  • For the Swiss group for clinical cancer research, section surgery
Colorectal Cancer

Abstract

Background

Functional outcomes of different reconstruction techniques have an impact on patients’ quality of life (QoL), but information on long-term QoL is lacking. We compared QoL among three reconstruction techniques after total mesorectal excision (TME).

Methods

Quality of life was assessed within a randomized, multicenter trial comparing rectal surgery using side-to-end anastomosis (SEA), colon J-pouch (CJP), and straight colorectal anastomosis (SCA) by the Functional Assessment of Cancer Therapy-Colorectal scale (FACT-C) before randomization and every 6 months up to 2 years post-TME. The primary QoL endpoint was the change in the Trial Outcome Index (TOI), including the FACT-C subscales of physical and functional well-being and colorectal cancer symptoms (CSS), from baseline to month 12. Pair-wise comparisons of changes from baseline (presurgery) to each timepoint between the three arms were analyzed by Mann–Whitney tests.

Results

For the QoL analysis, 257 of 336 randomized patients were in the per protocol evaluation (SEA = 95; CJP = 63; SCA = 99). Significant differences between the reconstruction techniques were found for selected QoL scales up to 12 months, all in favor of CJP. Patients with SEA or SCA reported a clinically relevant deterioration for TOI and CSS at 6 months, those with SCA for CSS also at 12 months after TME. Patients with CJP remained stable.

Conclusions

Although the three reconstruction techniques differ in their effects on QoL at months 6 and 12, these differences did not persist over the whole observation period of 24 months. Patients with a colon J-pouch may benefit with respect to QoL in the short-term.

Notes

Acknowledgment

This work was partially supported by a grant from Oncosuisse (OCS 01579-08-2004) and by the Swiss State Secretariat for Education, Research and Innovation (SERI).

Supplementary material

10434_2019_7525_MOESM1_ESM.docx (86 kb)
Supplementary material 1 (DOCX 85 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Karin Ribi
    • 1
    • 8
    Email author
  • Walter R. Marti
    • 2
  • Jürg Bernhard
    • 1
    • 3
  • Felix Grieder
    • 4
  • Michael Graf
    • 5
  • Beat Gloor
    • 3
  • Gaudenz Curti
    • 2
  • Markus Zuber
    • 6
  • Nicolas Demartines
    • 7
  • Christiane Andrieu
    • 8
  • Martin Bigler
    • 8
  • Stefanie Hayoz
    • 8
  • Heinz Wehrli
    • 9
  • Christoph Kettelhack
    • 10
  • Bruno Lerf
    • 11
  • Fabrizio Fasolini
    • 12
  • Christian Hamel
    • 13
  • For the Swiss group for clinical cancer research, section surgery
  1. 1.International Breast Cancer Study Group (IBCSG) Coordinating CenterBernSwitzerland
  2. 2.Kantonsspital Aarau now at chirurgieaarauAarauSwitzerland
  3. 3.Bern University HospitalInselspitalBernSwitzerland
  4. 4.Kantonsspital WinterthurWinterthurSwitzerland
  5. 5.Luzerner Kantonsspital now at Spital MuensterlingenMuensterlingenSwitzerland
  6. 6.Kantonsspital SolothurnSolothurnSwitzerland
  7. 7.Centre hospitalier universitaire vaudoiseLausanneSwitzerland
  8. 8.SAKK Coordinating CenterBernSwitzerland
  9. 9.Zürich HirslandenklinikZurichSwitzerland
  10. 10.Universitätsspital BaselBaselSwitzerland
  11. 11.Kantonsspital ZugBaarSwitzerland
  12. 12.Ospedale regionale di Mendrisio Beata VergineMendrisioSwitzerland
  13. 13.Kreiskliniken LörrachLörrachGermany

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