title: Bowel function and quality of life after local excision or total mesorectal excision following chemoradiotherapy for rectal cancer.
abstract: BACKGROUND
  Local excision for rectal cancer is expected to offer a better functional outcome than conventional surgery. The aim of the present study was to compare quality of life and bowel function in patients with rectal cancer who underwent either local excision or conventional surgery after chemoradiotherapy.
  
  
  METHODS
  This was a retrospective multicentre study. Patients who underwent local excision were compared with those who had mesorectal excision. Quality of life and bowel function were investigated using validated questionnaires (European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-CR29 and Memorial Sloan-Kettering Cancer Center Bowel Function Instrument) at a median follow-up of 49 (range 13-95) months. Further analysis was undertaken of data from patients who underwent local excision alone compared with those requiring subsequent radical surgery. Statistical significance was set at P < 0·010.
  
  
  RESULTS
  The mean constipation score was significantly better in the local excision group than in the mesorectal excision group (3·8 (95 per cent c.i. 0·3 to 7·2) versus 19·8 (12·1 to 27·4); P < 0·001). Compared with patients who underwent mesorectal excision, those who had local excision had less sensation of incomplete emptying (mean score 3·7 (3·4 to 4·0) versus 2·8 (2·5 to 3·1); P < 0·001) and second bowel movements within 15 min (mean score 3·6 (3·3 to 3·9) versus 3·0 (2·7 to 3·3); P = 0·006). Patients who underwent local excision alone scored better than those who had mesorectal excision, particularly for bowel function, who, in turn, scored better than patients requiring subsequent radical surgery following local excision.
  
  
  CONCLUSIONS
  Patients who underwent local excision had a better quality of life and bowel function than those who underwent mesorectal excision.
authors.affiliation: Departments of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pucciarelli
authors.affiliation: Departments of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giandomenico
authors.affiliation: Department of Radiation Oncology, National Cancer Institute, Aviano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Paoli
authors.affiliation: Developmental Psychology and Socialization, University of Padua, Padua, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Gavaruzzi
authors.affiliation: Developmental Psychology and Socialization, University of Padua, Padua, Italy.|Centre for Cognitive Neuroscience, University of Padua, Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lotto
authors.affiliation: Department of Radiotherapy, Ospedali Riuniti, Ancona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mantello
authors.affiliation: Department of Radiotherapy, Catholic University of Rome, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Barba
authors.affiliation: Psycho-Oncology Unit, National Cancer Institute, Aviano, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Zotti
authors.affiliation: Department of Radiation Oncology, National Cancer Institute, Aviano, Italy.|Psycho-Oncology Unit, National Cancer Institute, Aviano, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Flora
authors.affiliation: Istituto Oncologico Veneto (IOV-IRCCS), Padua, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Del Bianco
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D003248:Constipation / Q000150:complications; D003672:Defecation; D005242:Fecal Incontinence / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires