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)

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dc.contributor.authorMercieca-Bebber, R.
dc.contributor.authorEggins, R.
dc.contributor.authorBrown, K.
dc.contributor.authorGebski, V.J.
dc.contributor.authorBrewer, K.
dc.contributor.authorLai, L.
dc.contributor.authorBailey, L.
dc.contributor.authorSolomon, M.J.
dc.contributor.authorLumley, J.W.
dc.contributor.authorHewett, P.
dc.contributor.authorClouston, A.D.
dc.contributor.authorWilson, K.
dc.contributor.authorHague, W.
dc.contributor.authorHayes, J.
dc.contributor.authorWhite, S.
dc.contributor.authorMorgan, M.
dc.contributor.authorSimes, R.J.
dc.contributor.authorStevenson, A.R.L.
dc.date.issued2023
dc.description.abstractObjective: 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, (Rebecca.mercieca@sydney.edu.au., 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.
dc.description.statementofresponsibilityRebecca Mercieca-Bebber, Renee Eggins, Kilian Brown, Val J. Gebski, Kate Brewer, Lenna Lai, Lisa Bailey, Michael J. Solomon, John W. Lumley, Peter Hewett, Andrew D. Clouston, Kate Wilson, Wendy Hague, Julian Hayes, Stephen White, Matt Morgan, R. John Simes and Andrew R. L. Stevenson
dc.identifier.citationAnnals of Surgery, 2023; 277(3):449-455
dc.identifier.doi10.1097/SLA.0000000000005412
dc.identifier.issn0003-4932
dc.identifier.issn1528-1140
dc.identifier.urihttps://hdl.handle.net/2440/146084
dc.language.isoen
dc.publisherLippincott, Williams & Wilkins
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1009973
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1078113
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1138100
dc.rightsCopyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1097/sla.0000000000005412
dc.subjectClinical trial, laparoscopic surgery, laparoscopic-assisted rectal cancer resection, open rectal cancer resection, patient-reported outcomes, quality of life, rectal cancer, sexual functioning
dc.subject.meshRectum
dc.subject.meshHumans
dc.subject.meshRectal Neoplasms
dc.subject.meshLaparoscopy
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshPatient Reported Outcome Measures
dc.subject.meshProctectomy
dc.titlePatient-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)
dc.typeJournal article
pubs.publication-statusPublished

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