Evaluation of the Extended Surgery for Rectal Cancer on the Quality of Postoperative Life

Masayuki Yasutomi

Department of Surgery, Kinki University School of Medicine

Patients with colorectal cancer who received radical surgery from 1975 to 1988 were evaluated from the viewpoint of the extended surgery and postoperative quality of life (Q.L.). Assessment was by questionnaire on the colostomy after abdominoperineal resection (APR). APR is regarded as an extendd operation, because 68% of rectal cancers are treated by a sphincter saving operation and only 32% by APR. In spite of guidance by enterostomal therapists, 75.8% of 132 APR patients complained of irregular bowel movements, 37.9% of expulsion of gas and 34.8% of an offensive odor. Dietary restriction was common and 59.1% of the patiens with APR refrained from overeating and from eating irritating and fatty food. After pelvic node disseaction, 51.2% of the patients showed mild or moderate dysuria and 43.5% severe dysuria, while the incidence was 31% and l2.5%, respectively, after conventional dissection. Erectile male impotence was increased to 85.9% after pelvic node dissection from 71.2% after conventional dissection. 78.1% of patients returned to work and 21.2% retired from work after pelvic node dissection, while the corresponding figures were 86.5% and 13.5% after conventional dissection. Metastasis to the pelvic nodes occurred in 18 (12.2%) of 148 rectal cancer patients examined by the clearing method. The rate was increased to 30.8%, when we included cancers infilirating deeper beyond the muscle layer and located 6 cm or less from the anal verge. The actuarial survival was improved 6.2% after pelvic node dissection. Pelvic node dissection should by limited to cancers with a hgher incidence of nodal involvement.

Key words
extended surgery for rectal cancer, quality of life, pelvic nodes dissection

Reprint requests
Masayuki Yasutomi Department of Surgery, Kinki University School of Medicine
377-2 Ohnohigashi, Osaka-sayama, 589 JAPAN

Accepted
December 13, 1989

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