Patient-Reported Bowel, Urinary, and Sexual Outcomes After Laparoscopic-Assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial (ALaCart). Issue 3 (15th March 2023)

• Record Type: Journal Article
• Authors: Mercieca-Bebber, Rebecca; Eggins, Renee; Brown, Kilian; Gebski, Val J.; Brewer, Kate; Lai, Lenna; Bailey, Lisa; Solomon, Michael J.; Lumley, John W.; Hewett, Peter; Clouston, Andrew D.; Wilson, Kate; Hague, Wendy; Hayes, Julian; White, Stephen; Morgan, Matt; Simes, R. John; Stevenson, Andrew R. L.
• Is Part Of: Annals of surgery. Volume 277:Issue 3(2023)
• Page Start: 449
• Page End: 455
• Publication Date: 2023-03-15
• Subjects: clinical trial -- laparoscopic surgery -- laparoscopic-assisted rectal cancer resection -- open rectal cancer resection -- patient-reported outcomes -- quality of life -- rectal cancer -- sexual functioning; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000005412
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of this study was to compare patient-reported urinary, bowel, and sexual functioning of ALaCaRT Trial participants randomized to open or laparoscopic surgery for rectal cancer. Summary Background Data: The primary endpoint, noninferiority of laparoscopic surgical resection adequacy, was not established. Methods: Participants completed QLQ-CR29 at baseline, 3, and 12 months post-surgery. Additionally, women completed Rosen's Female Sexual Functioning Index (FSFI). Men completed the International Index of Erectile Function (IIEF) and QLQ-PR25. We compared the proportions of participants in each group who experienced moderate/severe symptoms/dysfunction at each time-point and compared mean difference scores from baseline to 12 months between groups. All analyses were intention-to-treat. Sexual functioning analyses included only the participants who expressed sexual interest at baseline. Results: Baseline PRO compliance of 475 randomized participants was 88%. At 12 months, a lower proportion of open surgery participants experienced moderate–severe fecal incontinence and sore skin, compared to Laparoscopic participants, and a lower proportion of men randomized to open surgery experienced moderate–severe urinary symptoms. There were no differences at 3 months for bowel or urinary symptoms. Sexual functioning among sexually interested participants was similar between groups at 3 and 12 months; however, a lower proportion of women reported moderate to severe sexual dissatisfaction at 3 months in the open as compared to the laparoscopic group, ([e-mail]., 95% CI 0.03–0.39). Discussion: Despite the slightly lower proportions of open surgery participants self-reporting moderate-severe symptoms for 3 of 16 urinary/bowel domains, and lack of differences in sexual domains, it remains difficult to recommend one surgical approach over another for rectal resection.