Outcomes

Mortality following radical surgery for rectal cancer ranges from 2 to 5% and major morbidity is common. There is a particularly high rate of perineal wound complications in patients undergoing preoperative radiation and APR. In addition, for those with permanent colostomy, there is a high lifetime rate of symptomatic peristomal hernia. Urinary and sexual dysfunction is significant, particularly in older males. Poor function may occur after restoration of intestinal continuity, particularly when a very distal rectal resection is required. The proximal colon is often noncompliant and cannot compensate for the loss of the reservoir function of the rectum. Radiation may also have a negative effect on the compliance of the remaining distal rectum and on sphincter function. Some will experience such lifealtering incontinence that ultimately a colostomy is constructed to improve quality of life.

Local recurrence is a significant problem after resection of rectal cancer. Disturbing differences in outcome between different surgeons and different centers have been found in terms of local recurrence, survival, and rate of permanent colostomy. Adherence to TME can result in significant reduction in local recurrence, improvement in survival and reduction in the permanent colostomy rate. The average rate of local recurrence after radical resection of rectal cancer in the past was as high as 30% but should be < 10% in the TME era. Local recurrence rates will be higher in patients with more aggressive disease, especially if the cancer is located in the distal rectum, regardless of the treatment protocol. Neoadjuvant therapy with chemoradiation may further decrease local recurrence rates.

The surgeon is clearly an important prognostic variable in the treatment of rectal cancer. Hospital procedure volume, surgeon procedure volume and surgical specialty have been found by many studies to affect outcome in terms of local recurrence, colostomy rates, and long term survival (Hodgson et al, 2003; Schrag et al, 2002). Higher volumes and increased specialization appear to be associated with better outcomes. Although not surprising, this volume-outcome relationship may have future implications in terms of regionalization of care.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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