Avaliação do impacto das disfunções intestinal e urinária na qualidade de vida de pacientes em pós-operatório tardio de ressecção anterior do reto por câncer

Abstract

Multimodal treatment of rectal cancer with the surgical procedures, radiotherapy, and chemotherapy, despite oncological success, can lead to genitourinary and intestinal dysfunctions, which can impact patients quality of life. Aims: To evaluate the occurrence of urinary and intestinal dysfunction (low anterior resection syndrome - LARS) in patients underwent anterior resection of the rectum by cancer and its impact on the quality of life. Methods: 169 patients submitted to rectal anterior resection by cancer, with at least one year of postoperative period after the time of the protective ostomy closure, responded to validated questionnaires to evaluate the intestinal function (LARS score) and the urinary function (IPSS), as well as quality of life questionnaires (EORTC QLQ-C30 and EORTC QLQ-CR29). Clinical and socio-demographic data were also obtained by a specific questionnaire. Possible factors related to the occurrence of dysfunctions and that could impact the quality of life were also investigated. Results: Intestinal dysfunction (LARS) was observed in 63.9% of patients, while 16% developed moderate or severe urinary dysfunction by IPSS. The median of the global health status was 83.33. A good physical function, role, emotional, cognitive, and social were observed. Patients with intestinal dysfunction were mostly underwent to total mesorectal excision (TME) and had anastomoses up to 5 cm from the anal margin, had moderate or severe urinary dysfunction, more diarrhea, more urinary frequency, and fecal incontinence. There was no significant difference in relation to the global health status in patients with or without intestinal dysfunction. Patients with moderate or severe urinary dysfunction presented predominantly with low level education, with associated intestinal dysfunction, more pain, insomnia, constipation, urinary incontinence, and sexual impotence. The worsening of the intestinal function by LARS score had little impact on the worsening of the global health status, while the worsening of the urinary function by the IPSS, led to negative impact on the global health status. Conclusions: Urinary and intestinal dysfunctions after anterior resection of rectum did not compromise the quality of life of most patients, and urinary dysfunctions caused a greater impact on the global health status than intestinal dysfunctions.