Warning: fopen(/home/virtual/colon/journal/upload/ip_log/ip_log_2025-03.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 95 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 96 Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Skip Navigation
Skip to contents

Ann Coloproctol : Annals of Coloproctology

OPEN ACCESS
SEARCH
Search
Advanced Search
mobile menu button

Articles

Page Path
HOME > Ann Coloproctol > Volume 40(6); 2024 > Article
Review
Colorectal cancer
 Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jungorcid
Annals of Coloproctology 2024;40(6):527-537.
DOI: https://doi.org/10.3393/ac.2024.00745.0106
Published online: December 20, 2024

Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Correspondence to: Won Beom Jung, MD. Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea Email: H00388@paik.ac.kr
• Received: October 17, 2024   • Revised: October 29, 2024   • Accepted: November 7, 2024

© 2024 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next
  • 1,166 Views
  • 76 Download
  • 1 Web of Science
  • 1 Crossref
  • 1 Scopus
Full Article

Download PDF Download PDF

  • Rectal cancer is one of the most common carcinomas and a leading cause of cancer-related mortality. Although significant advancements have been made in the treatment of rectal cancer, the deterioration of quality of life (QoL) remains a challenging issue. Various tools have been developed to assess QoL, including the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, the QLQ-C30 and QLQ-CR29 by the European Organization for Research and Treatment of Cancer (EORTC), and the 36-Item Short Form Health Survey (SF-36). Factors such as the lower location of the tumor, radiation therapy, chemoradiotherapy, and chemotherapy are associated with a decline in QoL. Furthermore, anastomotic leakage following rectal cancer resection is an important risk factor affecting QoL. With the development of novel treatment approaches, including neoadjuvant therapies such as chemoradiotherapy and total neoadjuvant therapy, the rate of clinical complete remission has increased, leading to the emergence of organ-preserving strategies. Both local excision and the “watch-and-wait” approach following neoadjuvant therapy improved functional outcomes and QoL. Efforts to improve QoL after rectal cancer surgery are ongoing in surgical techniques for rectal cancer. Since QoL is determined by a complex interplay of factors, including the patient's physical condition, surgical techniques, and psychological and social elements, a comprehensive approach is necessary to understand and enhance it. This review aims to describe the methods for measuring QoL in rectal cancer patients after surgery, the key risk factors involved, and various strategies and efforts to improve QoL outcomes.
  • Keywords: Quality of life; Chemoradiotherapy; Rectal neoplasms; Low anterior resection syndrome
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers worldwide and remains a major cause of cancer-related mortality [1–3]. However, with the advancements in treatment, particularly for rectal cancer, survival rates have significantly improved [2, 3]. For patients with advanced rectal cancer without systemic metastasis, the standard treatment approach, which includes total mesorectal excision (TME) and may involve concurrent chemoradiotherapy (CRT) administered preoperatively or postoperatively, followed by adjuvant chemotherapy, has greatly enhanced patient outcomes [4–7].
Over the past few decades, significant advancements in rectal cancer treatment—such as intersphincteric resection (ISR), transanal approach, multidisciplinary approaches, and total neoadjuvant treatment—have led to higher sphincter preservation rates [5–8]. However, patients who undergo sphincter-preserving resection (SPR) including low anterior resection (LAR) frequently experience postoperative symptoms like fecal urgency, frequent bowel movements, bowel fragmentation, and incontinence, collectively known as LAR syndrome (LARS) [7–9]. To alleviate LARS, various surgical techniques have been explored, and for select patients following neoadjuvant therapy, organ preservation has been proposed as a strategy to improve quality of life (QoL) [4, 9, 10]. However, a larger proportion of patients underwent sphincter-preserving radical resection, and LARS remains an important factor that considerably affects QoL after surgery. In addition, risk of nerve injury during radical surgery is one of the factors influence on postsurgical QoL. As survival rates have improved, there has been a growing emphasis on patients' QoL after treatment, regardless of whether surgery is involved. This review aims to examine the significance of QoL in rectal cancer patients, outline the methods used for its assessment, and highlight current efforts to enhance it alongside achieving oncological remission.
In the medical field, QoL is one of several important outcomes and should be assessed alongside other clinical factors, rather than on its own. Epstein [11] proposed a widely recognized classification system that distinguishes between traditional clinical outcomes (e.g., mortality, readmission, and complications) and emerging outcomes (e.g., functional status, emotional health, social interaction, cognitive function, and degree of disability) in medical care.
A 33-item general cancer QoL measure, known as Functional Assessment of Cancer Therapy (FACT) scale, was developed to evaluate cancer patients. This tool assesses physical, functional, social, and emotional well-being, as well as satisfaction with the treatment [12].
Subsequently, Ward et al. [13] and Cella et al. [12] devised the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, which was developed as the CRC-specific QoL assessment module within the Functional Assessment of Chronic Illness Therapy (FACIT) that combines FACT-General with the Colorectal Cancer Subscale (CCS). FACIT evaluates areas such as physical well-being, social/family well-being, relationship with the doctor, and emotional well-being. FACT-C address additional concerns specific to CRC patients, including abdominal pain, weight loss, bowel habits, digestion, diarrhea, appetite, self-esteem of appearance, and concerns about ostomy.
The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Study Group also developed a modular approach for assessing QoL in cancer patients [14, 15]. Their revised questionnaire, QLQ-C30, consists of 30 items, including 9 scales: 6 functional scales (physical, role, cognitive, emotional, and social functioning, and global QoL) and 3 symptom scales (fatigue, nausea and vomiting, and pain). It also includes 6 individual items assessing sleep disturbance, constipation, diarrhea, appetite loss, dyspnea, and the financial impact of the disease and treatment. Later, CRC-specific module (EORTC QLQ-C38) was added, which was eventually refined into the 29-item EORTC QLQ-CR29 [16–18]. This module focuses on sexual function, urinary and bowel function, body image, pain, bloating, dry mouth, hair loss, appetite, anxiety, weight, flatulence, skin pain, and ostomy-related problems. The 36-Item Short Form Health Survey (SF-36) is another effective tool, which assesses physical activity, social activity, role limitations due to physical and emotional problems, bodily pain, mental health, vitality, and general health perception [19]. It is widely acknowledged that QoL encompasses an individual’s subjective perception of well-being across 3 key domains: physical (intensity and frequency of symptoms and functional status), psychological (anxiety, depression, and positive experiences), and social (family life, employment, and sexuality) [19].
In addition, a Bowel Function Instrument was proposed, adapted from the Fecal Incontinence Quality of Life (FIQL) scale and the EORTC QLQ-C30 and QLQ-CR38 questionnaires [20]. The FIQL consists of 29 items, categorized into 4 domains: lifestyle (10 items), coping/behavior (9 items), depression/self-perception (7 items), and embarrassment (3 items) [21].
In addition to general QoL assessment tools, specific instruments are available to evaluate key aspects of patient well-being. The Wexner score, also known as the Cleveland Clinic Fecal Incontinence Score (CCFIS) is widely used to measure the severity of fecal incontinence [22], while the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) assess male and female sexual function, respectively [23, 24].
Due to the wide range of bowel changes that occur after rectal cancer surgery, the LARS score was developed to assess key symptoms beyond just fecal incontinence. Compared to the CCFIS, the LARS score has the advantage of reflecting a broader spectrum of postoperative changes. It has also been validated in multiple languages, making it widely applicable [8, 25].
Recently, patient-reported outcome measures (PROMs) have gained increasing importance in evaluating treatment outcomes, as they provide direct insights into the patients’ perspective on their QoL and functional status. PROMs are valuable because they capture subjective experiences, such as symptom burden and daily functioning, which may not be fully reflected in clinical or physician-reported data [7, 26]. This shift emphasizes patient-centered care, making PROMs a key component in assessing the overall effectiveness of treatments, especially in conditions like rectal cancer where long-term QoL is a major concern.
Commonly used QoL measurement tool for colorectal cancer is summarized in Table 1 [8, 13, 18, 19, 25].
Multiple factors would involve in determining QoL in rectal cancer patients after surgery or treatment (Fig. 1).
Age and sex
Both sex and age contribute to the variability in QoL after rectal cancer surgery. Women often report more issues related to bowel function, sexual health, and body image, while men may face challenges in sexual function and urinary control [27, 28]. Age also plays a crucial role, with younger patients generally experiencing a stronger impact on social and emotional well-being, as they may find it harder to adjust to lifestyle changes. In contrast, older patients may have more physical limitations but may adapt better emotionally to these changes [29, 30].
Several studies have investigated how age and sex affect the QoL in rectal cancer patients. A retrospective study by Schmidt et al. [29] involving 519 patients who underwent rectal cancer surgery, found that individuals aged ≥70 years were more likely to experience impaired physical functioning, poor global health, and fatigue. However, while older patients experienced increased strain early postoperative period, their condition improved over time. In contrast, patients aged ≤69 years experienced greater strain, primarily due to impaired sexual function, though their physical and role functioning were better. A study involving 137 patients who underwent SPR showed that those aged <60 years experienced more sexual issues, and that their global health status/QoL was closely tied to emotional functioning and future outlook. Patients aged ≥60 years had more micturition problems, and their global health status/QoL was significantly influenced by cognitive functioning, as shown by Kinoshita et al. [30].
In a population-based study, Thong et al. [27] found that among 479 rectal cancer patients, those diagnosed under 50 years reported worse functioning and more symptom burden compared to older patients. Younger patients, especially women, also reported lower sexual interest than men of the same age group. Lastly, a matched cross-sectional study reported that female rectal cancer patients with an ostomy had significantly worse QoL and mental well-being compared to male patients. The impact of ostomy on physical well-being was greater in younger women (<75 years) than in older women, as demonstrated by Krouse et al. [28].
Tumor location
The location of rectal cancer is usually considered a crucial factor in determining QoL after surgery. Several studies have reported that lower tumor location in rectal cancer is associated with a higher risk of complications [9, 31, 32] which may negatively affect QoL [31, 33, 34]. Additionally, when the tumor is located lower in the rectum, partial resection of the internal sphincter during anastomosis or the need for abdominoperineal resection (APR) is often required, both of which can further impair QoL [35, 36].
Lower tumor location has been reported to make patients more vulnerable to developing LARS, and this risk can be compounded when neoadjuvant therapy is added due to the tumor’s position. Studies have identified low tumor levels and neoadjuvant CRT as significant risk factors for delayed bowel dysfunction, as seen in patients with upper or middle rectal cancer 2 years after tumor resection [37]. Additionally, the distance of the tumor from the anal verge is significantly associated with a higher risk of LARS [9].
Radical forms of sphincter-preserving surgery such as ISR for rectal cancer are associated with a decline in QoL, although it showed serial improvement. Zhang et al. [35] evaluated changes in QoL and functional outcomes in 102 patients who underwent ISR for ultra-low rectal cancer. Significant improvements were observed in the incontinence by 12 months post-ileostomy reversal, while LARS scores improved only at 24 months. Kinoshita et al. [38] demonstrated that patients who underwent ISR had significantly worse QoL scores than those who underwent LAR. Additionally, Sun et al. [39] reported that patients who underwent conformal SPR had shorter hospital stays and greater QoL satisfaction than those who underwent ISR.
Restorative vs. nonrestorative surgery
The creation of a permanent ostomy may pose significant concerns regarding the psychological, physical, and social aspects of QoL. Patients with colostomies are more likely to experience feelings of stigma and reduced participation in social activities [36, 40]. However, this conclusion remains complex.
According to meta-analyses [36, 40], APR adversely affects QoL in rectal cancer patients, particularly in social functioning and body image, compared to sphincter-sparing surgeries. On the contrary, APR patients initially reported worse body image and micturition complaints, but overall QoL became comparable to SPR patients after recovery, indicating mixed effects on QoL [41–43].
Digennaro et al. [42] and Dumont et al. [43] reported that QoL in patients who underwent coloanal anastomosis (CAA) was not superior to that in patients with permanent stomas. According to these studies, patients with APR had poorer sexual function, whereas those with CAA had more incontinence. A meta-analysis of 19 studies comparing outcomes in patients with low rectal cancer reported no significant differences in the overall QoL and pain levels between patients who underwent APR and those who underwent CAA [44]. A Cochrane review of 26 studies concluded that there was insufficient evidence to definitively determine whether the QoL of patients who underwent SPR was superior to that of patients who underwent APR [45].
Meanwhile, a Korean group recently conducted a prospective multicenter trial (ASPIRE) regarding QoL after SPR or APR for low rectal cancer [46]. The study demonstrated no differences in the overall QoL between the 2 groups, although they recommended SPR over APR because of its association with improved sexual and urinary function. Patients without ostomies may also experience physical impairments, including altered bowel habits and psychological distress related to impaired sexual function, following SPRs.
Although APR is associated with risk of high sexual and urinary dysfunction, and impaired body image, but SPR is not universally recommended over APR in terms of QoL according to comprehensive evaluation. Patient-related, tumor-related, and social factors need to be considered to select type of surgery for rectal cancer.
Radiation therapy and chemotherapy
The introduction of chemotherapy and radiotherapy (RT) in the treatment of rectal cancer has significantly contributed to reducing recurrence rates and improving survival rates [4, 47, 48]. Recently, there has been a rapid increase in attempts to administer these treatments before considering surgery, aiming to diversify treatment approaches, improve patient compliance, and address potential distant metastases early on [4, 47, 48]. However, concerns have been consistently raised about the potential negative impact of these treatments on QoL although there are still controversies [48–51]. The Dutch TME trial revealed that TME with preoperative RT significantly reduced local recurrence but was associated with impaired bowel function, which affected QoL [48]. Radiation-induced early toxicity primarily includes diarrhea, cystitis, and perineal dermatitis, whereas late toxicity is characterized by bowel dysfunction, fecal incontinence, bleeding, perforation, and genitourinary dysfunction [50]. Although CRT demonstrates superiority over RT in terms of local control, it has been associated with a greater decline in QoL mainly caused by decline of bowel function than RT alone [37, 51].
A meta-analysis by Birgisson et al. [52] showed that late toxicities from RT, such as radiation-induced bowel obstruction and bowel dysfunction—which include symptoms like fecal incontinence to gas, loose or solid stools, and sexual dysfunction—play a significant role in reducing QoL. Similarly, a long-term study by Bruheim et al. [53] reported that patients who received RT and CRT groups had more frequent bowel movements (more than 8 per day), higher rated of urinary and fecal incontinence, greater reliance on sanitary pads, and a more difficulty controlling the urge to defecate compared to those who did not receive RT. The study also noted that the CRT and RT groups had lower global QoL and social functioning. Kinoshita et al. [54] conducted a prospective questionnaire-based study on patients who had surgery for lower rectal cancer. They found that those who receive chemotherapy had significantly lower physical and social functioning scores 12 months after surgery compared to those who did not. It is widely agreed that RT, CRT, and chemotherapy negatively impact although it is still controversial [49]. To improve outcomes, recommendations include using short-course RT, reducing irradiated area, applying advanced irradiation techniques, and tailoring chemotherapy regimens to individual patients instead of using standardized treatment [55]. Interestingly, Wagner et al. [56] reported that two-thirds of patients anticipated a curative outcome from their RT despite only one-third receiving RT with curative intent. Patients with higher expectations of recovery reported better QoL than those with lower expectations. These findings suggest that, while the actual effects of RT may not always meet patients’ expectations, the anticipation of a positive outcome appears to enhance QoL. Therefore, it is crucial to balance between providing realistic information about the effectiveness of RT and offering optimistic explanations to improve patients’ QoL.
Anastomotic leakage
Anastomotic leakage (AL) is a serious complication that can occur after rectal resection and is also known to be associated with functional decline and impairment of QoL [9, 34, 57–59]. Re et al. [34] conducted a retrospective audit that revealed an association between AL and elevated long-term fecal incontinence scores. Mongin et al. [59] demonstrated that patients with AL following laparoscopic SPR for mid and low rectal cancer exhibited significantly impaired physical activity, self-respect, and wear pad scores, as well as blood/mucus in the stool. However, no significant differences were observed in the overall Wexner scores. According to the retrospective cross-sectional study from Australia including 224 patients who underwent minimally invasive restorative rectal surgery with a low pelvic colorectal anastomosis, 11% of patients experienced AL and had worse LARS scores than those who did not have AL (P=0.028) [60].
Chronic leakage also influences on QoL. The institutional database-based study including long study period (1995–2019) analyzed the prevalence and factors influencing chronic AL after LAR for rectal cancer, with a focus on treatment of persistent presacral sinus and its impact on OoL [61]. Among 71 patients, 54.9% developed a chronic presacral sinus, and neoadjuvant therapies significantly influenced AL formation. While multiple therapies and surgical revisions negatively affected bowel continuity, stoma reversal notably improved long-term survival, bowel function, and pain relief, thereby enhancing patients' overall QoL. The study emphasizes that tailored surgical treatment and stoma reversal can significantly improve QoL for patients with chronic AL.
SPR and the W&W approach
There has been a shift in treatment strategies from previous studies focusing solely on complete resection of the tumor with TME and oncological outcomes toward an approach that also emphasizes treatment-related morbidity and QoL of patients [4, 62–64]. As part of this, there is an emerging strategy in the management of rectal cancer as an approach to “organ preservation,” such as local excision or the watch-and-wait (W&W) approach [62–64]. These approaches yield oncological outcomes comparable to those of TME, potentially enhancing QoL. In the management of early rectal cancer, local excision techniques such as transanal excision or transanal minimally invasive surgery are viable alternatives to TME [65–67], although prospective studies reported that fecal incontinence was more prevalent in patients who underwent CRT followed by local excision 1 year after surgery [66] and long surgery time is a risk factor of functional disorder [67]. Increasing evidence supports an observational approach, known as W&W strategy, which omits rectal resection after clinical complete remission following CRT or total neoadjuvant treatment since Habr-Gama et al. [68] pioneered a nonoperative management for rectal cancer patients who respond well to CRT. Several studies, including a retrospective analysis of the Memorial Sloan Kettering experience [10, 69], showed that rectal cancer patients using the W&W strategy had better functional outcomes compared to those who had surgery, though pelvic radiation did cause symptoms of major LARS in about one-third of W&W patients. However, the oncologic outcomes of the W&W strategy are still being evaluated to determine its reliability and proper selection of patients in the International Watch & Wait Database (IWWD) of 880 patients with clinical complete response, the 2-year cumulative incidence of local regrowth was 25.2%, the incidence of distant metastasis was 8%, and the 5-year overall survival rate was 85% [64]. Additionally, São Julião et al. [70] reported that patients in the W&W group who experienced local regrowth had a reduced distant metastases-free survival rate compared to those who underwent conventional TME after CRT from the time of local recurrence. Therefore, efforts should be made by applying stricter criteria for determining clinical complete response and shortening follow-up intervals.
Reducing toxicity of RT
In efforts to reduce the toxicity associated with RT for rectal cancer, several strategies have been developed to customize treatment and improve patient QoL and not compromising oncologic outcomes.
The use of short-course radiation therapy, which delivers a higher dose of radiation over a shorter period, can minimize the duration of treatment and reduce long-term side effects while maintaining comparable efficacy compared to conventional long-course radiation [71, 72], Another customization in RT is the reduction of irradiated volumes. By using advanced imaging techniques, RT can be more precisely targeted to the tumor, sparing healthy surrounding tissues such as the bladder and small bowel. This precision leads to fewer complications and reduced toxicity [73].
Advanced irradiation techniques have also played an important role in minimizing toxicity. Intensity-modulated radiation therapy (IMRT) allows for precise dose distribution around the tumor while minimizing exposure to nearby organs. Studies show that IMRT can significantly reduce gastrointestinal and genitourinary side effects in rectal cancer patients compared to conventional techniques [74]. Volumetric modulated arc therapy (VMAT), which delivers radiation in a continuous arc around the patient, offers similar benefits but with shorter treatment times, further improving patient comfort and reducing radiation exposure [75].
Lowering radiation doses or modifying the fractionation schedule (how radiation is divided across treatment sessions) can also reduce toxicity, particularly in patients at high risk for side effects. Tailoring the dose based on patient-specific factors, such as age or co-existing health conditions, can balance efficacy and toxicity more effectively. Bowel-sparing techniques are another way to reduce the toxic effects of radiation. Approaches such as prone positioning (where the patient lies face down) or the use of belly boards help to move the small bowel away from the radiation field, minimizing the risk of bowel toxicity [76].
Recently, personalized treatment planning based on genetic markers, patient-specific anatomy, or prior treatment responses enables further customization of RT. Personalized plans can better minimize toxicity while still achieving high oncologic control [77].
These advanced techniques and approaches are essential for optimizing RT in rectal cancer, reducing treatment-related toxicity, and improving QoL while ensuring effective cancer control.
Operative techniques for preserving QoL
Various operative techniques have emerged to enhance QoL.

Minimally invasive surgery

Various approaches have been introduced to improve oncologic outcomes as well as QoL [78–80]. Various studies suggest that a robotic approach for rectal cancer better preserves urogenital function by providing a better visual field and ergonomic control system considering patients body habitus and disease status [78–80].

Low ligation of IMA

Whether high ligation of the inferior mesenteric artery (IMA) negatively impact on functional outcomes is still controversial. A randomized clinical trial (RCT) conducted by Mari et al. [81] (the HIGHLOW trial) reported that low ligation of IMA resulted in significantly better outcomes than high ligation in terms of urinary parameters, including urinary volume, postvoid residual volume, maximum urinary flow, and flow time. On the contrary, another RCT showed no difference in QoL between 2 groups [82]. The level of IMA ligation is not a definitive factor of worsening QoL. However, care must be taken to avoid injury of the parasympathetic nerve trunk during IMA ligation. High ligation is more associated with a greater susceptibility to traumatic or thermal injury compared to low ligation. However, more evidence is required to reach consensus whether the level of IMA ligation influence on functional outcomes.

Colonic pouch and coloplasty

There were effort to improve bowel function by increasing reservoir volume. Chen et al. [83] conducted a retrospective study involving 72 patients with low rectal cancer who underwent SPR with either end-to-end or colonic pouch anastomosis. This study demonstrated that patients with colonic pouch anastomosis had lower postoperative LARS scores than those with end-to-end anastomosis, indicating improved bowel function.
RCTs by Fazio et al. [84] and Hallböök et al. [85] compared the functional outcomes of coloplasty, colonic J-pouch, and straight anastomosis following the resection of lower rectal cancer. The studies found that patients who underwent colonic J-pouch anastomosis had fewer bowel movements, less clustering, reduced pad use, and a lower fecal incontinence severity index than the other procedure groups.
However, several studies did not find any significant difference in QoL between colonic J-pouch and straight colorectal reconstruction in long-term results [86–88]. Reservoir anastomosis approach may be beneficial for early bowel function recovery although long-term benefit is not clear.
Rectal cancer treatment has undergone rapid advancements over the past few decades owing to the development of various treatment modalities and multidisciplinary approaches. In this study, we reviewed the key indicators for assessing QoL, factors contributing to QoL deterioration, and efforts to improve QoL postoperatively in patients with rectal cancer. As different treatment approaches and strategies to enhance QoL have both benefits and limitations, it is essential to provide patients with comprehensive information and ensure that informed consent is obtained.

Conflict of interest

Won Beom Jung is an Editorial Board member of Annals of Coloproctology, but was not involved in the reviewing or decision process of this manuscript. No other potential conflict of interest relevant to this article was reported.

Funding

None.

Fig. 1.
Factors related with quality of life (QoL) after rectal cancer surgery. Multiple patient-related, disease-specific, and surgery-related factors involve in determining QoL. APR, abdominoperineal resection; SPR, sphincter-preserving resection.
ac-2024-00745-0106f1.jpg
Table 1.
Various assessment tools of QoL in rectal cancer patients
Assessment tool Description Score Domain Strength Limitation
LARS score [8, 25] Assess bowel function Range, 0–42 points Gas incontinence Specific to bowel function Limited to bowel function
No LARS (0–20) Liquid stool incontinence Quick and simple to use Does not address QoL
Minor LARS (21–29) Evacuation frequency
Major LARS (30–42) Fragmented evacuation
Defecation urgency
FACT-C [13] Multidimensional QoL tool with a CRC-specific subscale Range, 0–136 points Physical well-being Comprehensive view of QoL in CRC Lengthy
Higher scores indicate better QoL Social/family well-being May require more training for accurate interpretation
Total and domain-specific scores analysis Emotional well-being
Focus on changes over time to evaluate pretreatment and posttreatment QoL Functional well-being
CRC-specific concerns
EORTC QLQ-CR29 [18] Evaluate CRC-related symptoms and functions Range, 0–100 points (for each domain) Body image Tailored to CRC patients Lengthy
Function domain: higher scores indicate better function Sexual function Covers a wide range of symptom areas May require healthcare professional assistance for accurate completion
Symptom domain: higher scores indicate more severe symptoms or issues Gastrointestinal symptoms (e.g., diarrhea, constipation, bloating)
Interpreting domain-specific scores and changes over time Urinary symptoms
Treatment-related side effects
SF-36 [19] Assess general health status Range, 0–100 points (for each domain) Physical functioning Widely used and validated across various conditions Not cancer-specific
Higher scores in each domain indicate better health status Role limitations due to physical health Broad QoL coverage allows comparison across diseases
Average scores and track changes over time Role limitations due to emotional problems
Energy/fatigue
Emotional well-being
Social functioning
Pain
General health perception

QoL, quality of life; LARS, low anterior resection syndrome; FACT-C, Functional Assessment of Cancer Therapy-Colorectal; CRC, colorectal cancer; EORTC, European Organization for Research and Treatment of Cancer; SF-36, 36-Item Short Form Health Survey.

  • 1. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023;73:233–54. ArticlePubMedPDF
  • 2. Park EH, Jung KW, Park NJ, Kang MJ, Yun EH, Kim HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2021. Cancer Res Treat 2024;56:357–71. ArticlePubMedPMCPDF
  • 3. Kim MH, Park S, Yi N, Kang B, Park IJ. Colorectal cancer mortality trends in the era of cancer survivorship in Korea: 2000–2020. Ann Coloproctol 2022;38:343–52. ArticlePubMedPMCPDF
  • 4. Sychev S, Ponomarenko A, Chernyshov S, Alekseev M, Mamedli Z, Kuzmichev D, et al. Total neoadjuvant therapy in rectal cancer: a network meta-analysis of randomized trials. Ann Coloproctol 2023;39:289–300. ArticlePubMedPMCPDF
  • 5. Neary E, Ibrahim T, Verschoor CP, Zhang L, Patel SV, Chadi SA, et al. A systematic review and meta-analysis of oncological outcomes with transanal total mesorectal excision for rectal cancer. Colorectal Dis 2024;26:837–50. ArticlePubMed
  • 6. Guo Y, He L, Tong W, Ren S, Chi Z, Tan K, et al. Intersphincteric resection following robotic-assisted versus laparoscopy-assisted total mesorectal excision for middle and low rectal cancer: a multicentre propensity score analysis of 1571 patients. Int J Surg 2024;110:1904–12. ArticlePubMedPMC
  • 7. van der Heijden JA, van de Pas KG, van den Broek FJ, van Dielen FM, Slooter GD, Maaskant-Braat AJ. Oncological and functional outcomes of transanal total mesorectal excision in a teaching hospital in the Netherlands. Ann Coloproctol 2022;38:28–35. ArticlePubMedPMCPDF
  • 8. Keane C, Fearnhead NS, Bordeianou L, Christensen P, Espin Basany E, Laurberg S, et al. International consensus definition of low anterior resection syndrome. Colorectal Dis 2020;22:331–41. ArticlePubMedPDF
  • 9. Lim SL, Wan Zain WZ, Zahari Z, Zakaria AD, Hashim MN, Wong MP, et al. Risk factors associated with low anterior resection syndrome: a cross-sectional study. Ann Coloproctol 2023;39:427–34. ArticlePubMedPMCPDF
  • 10. Smith JJ, Strombom P, Chow OS, Roxburgh CS, Lynn P, Eaton A, et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy. JAMA Oncol 2019;5:e185896. ArticlePubMedPMC
  • 11. Epstein AM. The outcomes movement: will it get us where we want to go? N Engl J Med 1990;323:266–70. ArticlePubMed
  • 12. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 1993;11:570–9. ArticlePubMed
  • 13. Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Qual Life Res 1999;8:181–95. ArticlePubMed
  • 14. Sprangers MA, Cull A, Bjordal K, Groenvold M, Aaronson NK. The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. Qual Life Res 1993;2:287–95. ArticlePubMedPDF
  • 15. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–76. ArticlePubMed
  • 16. Sprangers MA, Cull A, Groenvold M, Bjordal K, Blazeby J, Aaronson NK. The European Organization for Research and Treatment of Cancer approach to developing questionnaire modules: an update and overview. Qual Life Res 1998;7:291–300. PubMed
  • 17. Whistance RN, Conroy T, Chie W, Costantini A, Sezer O, Koller M, et al. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer 2009;45:3017–26. ArticlePubMed
  • 18. Gujral S, Conroy T, Fleissner C, Sezer O, King PM, Avery KN, et al. Assessing quality of life in patients with colorectal cancer: an update of the EORTC quality of life questionnaire. Eur J Cancer 2007;43:1564–73. ArticlePubMed
  • 19. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473–83. PubMed
  • 20. Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 2005;48:1353–65. ArticlePubMed
  • 21. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 1999;42:1525–32. ArticlePubMed
  • 22. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97. ArticlePubMed
  • 23. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–30. Article
  • 24. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26:191–208. ArticlePubMed
  • 25. Buzatti KC, Petroianu A, Laurberg S, Silva RG, Rodrigues BD, Christensen P, et al. Validation of low anterior resection syndrome score in Brazil with Portuguese. Ann Coloproctol 2023;39:402–9. ArticlePubMedPMCPDF
  • 26. Harrison NJ, Lopez AA, Shroder MM, Bachmann JM, Burnell E, Hopkins MB, et al. Collection and utilization of patient-reported outcome measures in a colorectal surgery clinic. J Surg Res 2022;280:515–25. ArticlePubMedPMC
  • 27. Thong MS, Doege D, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, et al. Age at diagnosis and sex are associated with long-term deficits in disease-specific health-related quality of life of survivors of colon and rectal cancer: a population-based study. Dis Colon Rectum 2019;62:1294–304. ArticlePubMed
  • 28. Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler MJ, et al. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol 2009;27:4664–70. ArticlePubMedPMC
  • 29. Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B. Impact of age on quality of life in patients with rectal cancer. World J Surg 2005;29:190–7. ArticlePubMedPDF
  • 30. Kinoshita Y, Izukura R, Miyazono M, Nagai S, Oki E, Kanaoka M, et al. Effect of age factors on health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: a 1-year longitudinal study. Arch Gerontol Geriatr 2018;79:185–91. ArticlePubMed
  • 31. Yang H, Yao Z, Cui M, Xing J, Zhang C, Zhang N, et al. Influence of tumor location on short- and long-term outcomes after laparoscopic surgery for rectal cancer: a propensity score matched cohort study. BMC Cancer 2020;20:761.ArticlePubMedPMCPDF
  • 32. Roxburgh CS, Strombom P, Lynn P, Gonen M, Paty PB, Guillem JG, et al. Role of the interval from completion of neoadjuvant therapy to surgery in postoperative morbidity in patients with locally advanced rectal cancer. Ann Surg Oncol 2019;26:2019–27. ArticlePubMedPMCPDF
  • 33. van Kooten RT, Elske van den Akker-Marle M, Putter H, Meershoek-Klein Kranenbarg E, van de Velde CJ, Wouters MW, et al. The impact of postoperative complications on short- and long-term health-related quality of life after total mesorectal excision for rectal cancer. Clin Colorectal Cancer 2022;21:325–38. ArticlePubMed
  • 34. Re AD, Tooza S, Diab J, Karam C, Sarofim M, Ooi K, et al. Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life. Ann Coloproctol 2023;39:395–401. ArticlePDF
  • 35. Zhang B, Zhuo GZ, Zhao Y, Zhao YJ, Zhu J, Liu FF, et al. Quality of life and functional outcomes after intersphincteric resection for ultralow rectal cancer: a prospective observational study. Dis Colon Rectum 2023;66:1029–38. ArticlePubMed
  • 36. Yuge K, Miwa K, Fujita F, Murotani K, Shigaki T, Yoshida N, et al. Comparison of long-term quality of life based on surgical procedure in patients with rectal cancer. Front Oncol 2023;13:1197131.ArticlePubMedPMC
  • 37. Sakr A, Yang SY, Cho MS, Hur H, Min BS, Lee KY, et al. Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study. Ann Coloproctol 2024;40:27–35. ArticlePubMedPMCPDF
  • 38. Kinoshita Y, Nokes KM, Kawamoto R, Kanaoka M, Miyazono M, Nakao H, et al. Health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: a prospective 6-month follow-up study. Eur J Cancer Care (Engl) 2017;26:e12417. ArticlePubMedPDF
  • 39. Sun G, Zang Y, Ding H, Chen Y, Groothof D, Gong H, et al. Comparison of anal function and quality of life after conformal sphincter preservation operation and intersphincteric resection of very low rectal cancer: a multicenter, retrospective, case-control analysis. Tech Coloproctol 2023;27:1275–87. ArticlePubMedPMCPDF
  • 40. Maslyankov S, Penchev D, Todorov G, Vladov N. A meta-analysis of quality of life, estimated by questionnaires of the European Organization for Research and Treatment of Cancer (EORTC) after rectal cancer surgery. Chirurgia (Bucur) 2015;110:356–61. PubMed
  • 41. Maguire B, Clancy C, Connelly TM, Mehigan BJ, McCormick P, Altomare DF, et al. Quality of life meta-analysis following coloanal anastomosis versus abdominoperineal resection for low rectal cancer. Colorectal Dis 2022;24:811–20. ArticlePDF
  • 42. Digennaro R, Tondo M, Cuccia F, Giannini I, Pezzolla F, Rinaldi M, et al. Coloanal anastomosis or abdominoperineal resection for very low rectal cancer: what will benefit, the surgeon's pride or the patient’s quality of life? Int J Colorectal Dis 2013;28:949–57. ArticlePubMedPDF
  • 43. Dumont F, Ayadi M, Goéré D, Honoré C, Elias D. Comparison of fecal continence and quality of life between intersphincteric resection and abdominoperineal resection plus perineal colostomy for ultra-low rectal cancer. J Surg Oncol 2013;108:225–9. ArticlePubMedPDF
  • 44. Lawday S, Flamey N, Fowler GE, Leaning M, Dyar N, Daniels IR, et al. Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review. BJS Open 2021;5:zrab101.ArticlePubMedPMCPDF
  • 45. Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev 2012;12:CD004323.ArticlePubMed
  • 46. Kang SB, Cho JR, Jeong SY, Oh JH, Ahn S, Choi S, et al. Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): a long-term prospective, multicentre, cohort study. Lancet Reg Health West Pac 2020;6:100087.ArticlePubMedPMC
  • 47. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:1114–23. ArticlePubMed
  • 48. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46. ArticlePubMed
  • 49. Yoo RN, Kye BH, Kim H, Kim G, Cho HM. The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year. Ann Coloproctol 2023;39:32–40. ArticlePubMedPMCPDF
  • 50. Joye I, Haustermans K. Early and late toxicity of radiotherapy for rectal cancer. Recent Results Cancer Res 2014;203:189–201. Article
  • 51. Brændengen M, Tveit KM, Bruheim K, Cvancarova M, Berglund Å, Glimelius B. Late patient-reported toxicity after preoperative radiotherapy or chemoradiotherapy in nonresectable rectal cancer: results from a randomized phase III study. Int J Radiat Oncol Biol Phys 2011;81:1017–24. ArticlePubMed
  • 52. Birgisson H, Påhlman L, Gunnarsson U, Glimelius B. Late adverse effects of radiation therapy for rectal cancer: a systematic overview. Acta Oncol 2007;46:504–16. ArticlePubMed
  • 53. Bruheim K, Guren MG, Skovlund E, Hjermstad MJ, Dahl O, Frykholm G, et al. Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2010;76:1005–11. Article
  • 54. Kinoshita Y, Ohkusa T, Izukura R, Chishaki A, Mibu R. Effects of chemotherapy on the health-related quality of life of Japanese lower rectal cancer patients after sphincter-saving surgery. J Psychosoc Oncol 2017;35:468–82. Article
  • 55. Braendengen M, Tveit KM, Berglund A, Birkemeyer E, Frykholm G, Påhlman L, et al. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol 2008;26:3687–94. ArticlePubMed
  • 56. Wagner K, Koller M, Keil A, Trott D, Engenhart-Cabillic R, Pfab R, et al. Radiotherapy in surgical and nonsurgical patients: therapy expectations, quality of life and physician assessment. Chirurg 1998;69:252–8. German. ArticlePubMedPDF
  • 57. Arron MN, Custers JA, van Goor H, van Duijnhoven FJ, Kampman E, Kouwenhoven EA, et al. The association between anastomotic leakage and health-related quality of life after colorectal cancer surgery. Colorectal Dis 2023;25:1381–91. Article
  • 58. Riss S, Stremitzer S, Riss K, Mittlböck M, Bergmann M, Stift A. Pelvic organ function and quality of life after anastomotic leakage following rectal cancer surgery. Wien Klin Wochenschr 2011;123:53–7. ArticlePubMedPDF
  • 59. Mongin C, Maggiori L, Agostini J, Ferron M, Panis Y. Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study. Int J Colorectal Dis 2014;29:459–67. ArticlePubMedPDF
  • 60. McGiffin T, Clark DA, Edmundson A, Steffens D, Stevenson A, Solomon M. Surgical management and long-term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy. ANZ J Surg 2022;92:806–12. ArticlePubMedPDF
  • 61. Ponholzer F, Klingler CP, Gasser E, Gehwolf P, Ninkovic M, Bellotti R, et al. Long-term outcome after chronic anastomotic leakage following surgery for low rectal cancer. Int J Colorectal Dis 2022;37:1807–16. ArticlePubMedPMCPDF
  • 62. Park IJ. Precision medicine for primary rectal cancer will become a reality. Ann Coloproctol 2022;38:281–2. ArticlePubMedPMCPDF
  • 63. Dulskas A, Caushaj PF, Grigoravicius D, Zheng L, Fortunato R, Nunoo-Mensah JW, et al. International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment. Ann Coloproctol 2023;39:307–14. ArticlePubMedPMCPDF
  • 64. van der Valk MJ, Hilling DE, Bastiaannet E, Meershoek-Klein Kranenbarg E, Beets GL, Figueiredo NL, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet 2018;391:2537–45. ArticlePubMed
  • 65. Ng JY, Chen CC. Transanal total mesorectal excision for rectal cancer: it’s come a long way and here to stay. Ann Coloproctol 2022;38:283–9. ArticlePubMedPMCPDF
  • 66. Lynn PB, Renfro LA, Carrero XW, Shi Q, Strombom PL, Chow O, et al. Anorectal function and quality of life in patients with early stage rectal cancer treated with chemoradiation and local excision. Dis Colon Rectum 2017;60:459–68. ArticlePubMedPMC
  • 67. Khomyakov E, Chernyshov S, Fomenko O, Rybakov E. Does transanal endoscopic microsurgery affect rectal function? Ann Coloproctol 2023;39:326–31. ArticlePDF
  • 68. Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U Jr, Silva e Sousa AH Jr, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004;240:711–8. Article
  • 69. Hupkens BJ, Martens MH, Stoot JH, Berbee M, Melenhorst J, Beets-Tan RG, et al. Quality of life in rectal cancer patients after chemoradiation: watch-and-wait policy versus standard resection: a matched-controlled study. Dis Colon Rectum 2017;60:1032–40. ArticlePubMed
  • 70. São Julião GP, Fernández LM, Vailati BB, Habr-Gama A, Azevedo JM, Santiago IA, et al. Local regrowth and the risk of distant metastases among patients undergoing watch-and-wait for rectal cancer: what is the best control group? Multicenter retrospective study. Dis Colon Rectum 2024;67:73–81. Article
  • 71. Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol 2012;30:3827–33. Article
  • 72. Hazen SJ, Sluckin TC, Intven MP, Beets GL, Beets-Tan RG, Borstlap WA, et al. Abandonment of routine radiotherapy for nonlocally advanced rectal cancer and oncological outcomes. JAMA Oncol 2024;10:202–11. ArticlePubMed
  • 73. Chiloiro G, Gani C, Boldrini L. Rectal cancer MRI guided radiotherapy: a practical review for the physician. Semin Radiat Oncol 2024;34:64–8. ArticlePubMed
  • 74. Zheng J, Xia Y, Sun L. A comprehensive evaluation of the application of the Halcyon(2.0) IMRT technique in long-course radiotherapy for rectal cancer. Technol Cancer Res Treat 2022;21:15330338221074501.ArticlePDF
  • 75. Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, et al. Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009;92:118–24. ArticlePubMed
  • 76. Kószó R, Varga L, Fodor E, Kahán Z, Cserháti A, Hideghéty K, et al. Prone positioning on a belly board decreases rectal and bowel doses in pelvic intensity-modulated radiation therapy (IMRT) for prostate cancer. Pathol Oncol Res 2019;25:995–1002. ArticlePubMedPDF
  • 77. Yuan Z, Frazer M, Ahmed KA, Naqvi SM, Schell MJ, Felder S, et al. Modeling precision genomic-based radiation dose response in rectal cancer. Future Oncol 2020;16:2411–20. ArticlePubMed
  • 78. Pham TD, Larach T, Othman B, Rajkomar A, Heriot AG, Warrier SK, et al. Robotic natural orifice specimen extraction surgery (NOSES) for anterior resection. Ann Coloproctol 2023;39:526–30. ArticlePubMedPMCPDF
  • 79. Nocera F, Angehrn F, von Flüe M, Steinemann DC. Optimising functional outcomes in rectal cancer surgery. Langenbecks Arch Surg 2021;406:233–50. ArticlePubMedPMCPDF
  • 80. Kowalewski KF, Seifert L, Ali S, Schmidt MW, Seide S, Haney C, et al. Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis. Surg Endosc 2021;35:81–95. ArticlePubMedPMCPDF
  • 81. Mari GM, Crippa J, Cocozza E, Berselli M, Livraghi L, Carzaniga P, et al. Low ligation of inferior mesenteric artery in laparoscopic anterior resection for rectal cancer reduces genitourinary dysfunction: results from a randomized controlled trial (HIGHLOW trial). Ann Surg 2019;269:1018–24. ArticlePubMed
  • 82. Matsuda K, Hotta T, Takifuji K, Yokoyama S, Oku Y, Watanabe T, et al. Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery. Br J Surg 2015;102:501–8. ArticlePubMedPDF
  • 83. Chen ZZ, Li YD, Huang W, Chai NH, Wei ZQ. Colonic pouch confers better bowel function and similar postoperative outcomes compared to straight anastomosis for low rectal cancer. World J Gastrointest Surg 2021;13:303–14. ArticlePubMedPMC
  • 84. Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Fürst A, et al. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 2007;246:481–90. ArticlePubMedPMC
  • 85. Hallböök O, Påhlman L, Krog M, Wexner SD, Sjödahl R. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 1996;224:58–65. ArticlePubMedPMC
  • 86. Hallböök O, Hass U, Wänström A, Sjödahl R. Quality of life measurement after rectal excision for cancer: comparison between straight and colonic J-pouch anastomosis. Scand J Gastroenterol 1997;32:490–3. ArticlePubMed
  • 87. Gavaruzzi T, Pace U, Giandomenico F, Pucciarelli S, Bianco F, Selvaggi F, et al. Colonic J-pouch or straight colorectal reconstruction after low anterior resection for rectal cancer: impact on quality of life and bowel function: a multicenter prospective randomized study. Dis Colon Rectum 2020;63:1511–23. ArticlePubMed
  • 88. Wang Z. Colonic J-pouch versus side-to-end anastomosis for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. BMC Surg 2021;21:331.ArticlePubMedPMCPDF

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
      Eun Jung Park
      Science Editing.2025; 12(1): 66.     CrossRef

    • PubReader PubReader
    • Cite this Article
      Cite this Article
      export Copy Download
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Beyond survival: a comprehensive review of quality of life in rectal cancer patients
      Ann Coloproctol. 2024;40(6):527-537.   Published online December 20, 2024
      DOI: https://doi.org/10.3393/ac.2024.00745.0106
      Close
    • XML DownloadXML Download
    Figure
    • 0
    Related articles
    Beyond survival: a comprehensive review of quality of life in rectal cancer patients
    Image
    Fig. 1. Factors related with quality of life (QoL) after rectal cancer surgery. Multiple patient-related, disease-specific, and surgery-related factors involve in determining QoL. APR, abdominoperineal resection; SPR, sphincter-preserving resection.

    Fig. 1.

    Beyond survival: a comprehensive review of quality of life in rectal cancer patients
    Assessment tool Description Score Domain Strength Limitation
    LARS score [8, 25] Assess bowel function Range, 0–42 points Gas incontinence Specific to bowel function Limited to bowel function
    No LARS (0–20) Liquid stool incontinence Quick and simple to use Does not address QoL
    Minor LARS (21–29) Evacuation frequency
    Major LARS (30–42) Fragmented evacuation
    Defecation urgency
    FACT-C [13] Multidimensional QoL tool with a CRC-specific subscale Range, 0–136 points Physical well-being Comprehensive view of QoL in CRC Lengthy
    Higher scores indicate better QoL Social/family well-being May require more training for accurate interpretation
    Total and domain-specific scores analysis Emotional well-being
    Focus on changes over time to evaluate pretreatment and posttreatment QoL Functional well-being
    CRC-specific concerns
    EORTC QLQ-CR29 [18] Evaluate CRC-related symptoms and functions Range, 0–100 points (for each domain) Body image Tailored to CRC patients Lengthy
    Function domain: higher scores indicate better function Sexual function Covers a wide range of symptom areas May require healthcare professional assistance for accurate completion
    Symptom domain: higher scores indicate more severe symptoms or issues Gastrointestinal symptoms (e.g., diarrhea, constipation, bloating)
    Interpreting domain-specific scores and changes over time Urinary symptoms
    Treatment-related side effects
    SF-36 [19] Assess general health status Range, 0–100 points (for each domain) Physical functioning Widely used and validated across various conditions Not cancer-specific
    Higher scores in each domain indicate better health status Role limitations due to physical health Broad QoL coverage allows comparison across diseases
    Average scores and track changes over time Role limitations due to emotional problems
    Energy/fatigue
    Emotional well-being
    Social functioning
    Pain
    General health perception
    Table 1. Various assessment tools of QoL in rectal cancer patients

    QoL, quality of life; LARS, low anterior resection syndrome; FACT-C, Functional Assessment of Cancer Therapy-Colorectal; CRC, colorectal cancer; EORTC, European Organization for Research and Treatment of Cancer; SF-36, 36-Item Short Form Health Survey.

    Table 1.

    Ann Coloproctol : Annals of Coloproctology Twitter Facebook
    © Korean Society of Coloproctology.
    TOP