ORIGINAL ARTICLE   Free access

Minerva Chirurgica 2019 February;74(1):19-25

DOI: 10.23736/S0026-4733.18.07755-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Sphincter-saving proctectomy for rectal cancer with NO COIL® transanal tube and without ostoma. Clinical outcomes, cost effectiveness and quality of life in the elderly

Severino MONTEMURRO ¹, Michele AMMENDOLA ^{1, 2} ✉, Gaetano GALLO ², Roberto ROMANO ², Antonietta CONDOLUCI ², Lucia CURTO ², Stefano DE FRANCISCIS ³, Raffaele SERRA ³, Rosario SACCO ², Giuseppe SAMMARCO ²

¹ Unit of Surgery, Giovanni Paolo II Research Center, National Cancer Institute, Bari, Italy; ² Unit of Clinical Surgery, Department of Medical and Surgical Sciences, Magna Graecia University Medical School, Catanzaro, Italy; ³ Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy

BACKGROUND: Colorectal cancer is one of the most common invasive cancers, and it is responsible for considerable physical and psychosocial morbidity specially in older patients. However, only few reports focused on quality of life, cost-effectiveness and clinical outcomes of rectal cancer patients undergone to surgery. This retrospective study compares short-term and long-term outcomes in rectal cancer patients with more and less than 75 years of age.
METHODS: Four hundred consecutive patients underwent radical surgery for rectal adenocarcinoma and they were collected in a prospective institutional database and divided into two groups: group 1 (≥75 years, N.=98); group 2 (<75 years, N.=302). Rectal anterior resection (RAR) with sphincter-saving restorative proctectomy and with application of silicone transanal tube NO COIL® 60-80 mm long, was the only procedure considered. Main clinical and pathological data were assessed and compared.
RESULTS: Statistically significant differences between the two groups were detected regard to comorbidities and the emergency presentation. Overall survival is lower in patients over 75 age, but cancer-related survival is not different between the two groups.
CONCLUSIONS: Although advanced age is associated with higher morbidity and mortality, in our experience, itself is not a contraindication for surgical sphincter-saving proctetomy in rectal cancer patients. The absence of a stoma also improved the cost effectiveness and patients’ quality of life in both groups: psychological morbidity, sexuality, levels of anxiety and depression, body image.

KEY WORDS: Rectal neoplasms - Aged - Operative surgical procedures - Treatment outcome - Adenocarcinoma