Functional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation therapy, and sphincter preservation

PURPOSE: Locally advanced primary and recurrent rectal cancers treated with external beam radiation therapy, intraoperative radiation therapy, and che motherapy represent a complex group of patients in the setting of extensive pelvic surgery and sphincter preservation. We sought to define functional outcome and quality of life in this subset of patients. METHODS: We retrosp ectively reviewed our experience with locally advanced primary and recurren t rectal cancer patients who underwent intraoperative radiation therapy wit h either low anterior resection (n = 12) or coloanal anastomosis (n = 6) be tween 1991 and 1998. Current functional outcome and quality of life were ev aluated by a detailed questionnaire. RESULTS: Median time from operation to assessment was 24 (range, 6-93) months. Using a standardized Sphincter Fun ction Scale, incorporating the number of bowel movements per day and degree of incontinence, patients were graded as poor, fair, good, or excellent fu nction. Of all patients, 56 percent reported unfavorable (poor or fair) fun ction. Of the subset of patients with coloanal anastomosis or very low low anterior resection, 88 percent had unfavorable function as compared with 30 percent with standard low anterior resection. (P = 0.02; Fisher's exact pr obability test). A quality-of-life satisfaction score based on social, prof essional, and recreational restrictions demonstrated 56 percent of patients to be dissatisfied with their bowel function. CONCLUSIONS: The majority of patients with advanced rectal cancers who require external beam radiation therapy, extensive pelvic surgery, and intraoperative radiation therapy rep ort unfavorable functional and quality-of-life outcomes after sphincter pre servation. In this setting patients being considered for coloanal anastomos is or very low anterior resection may be better served by permanent diversi on.