colostomy or not? anorectal function after rectal cancer treatment. dr. anton titov, md: preserving anorectal function in colorectal cancer patients after surgery is very important. stoma is not always needed. anorectal function or need for stoma is a significant factor in quality of life for colorectal cancer patients. surgical operation for colorectal cancer affects anorectal function. the type of surgical operation that rectal cancer patient has affects anorectal function or need for colostomy. also radiation therapy side effects and potential complications from radiotherapy for colorectal cancer treatment affect anorectal function or colostomy requirement. how do you select the type of treatment for rectal cancer patients with the goal of preserving anorectal function after the treatment? when colostomy is required in rectal cancer? dr. torbjorn holm, md (rectal cancer surgeon, professor, karolinska institute, stockholm): need for colostomy after rectal cancer treatment is a very good question. it is a very very difficult question. because the primary goal in the treatment of colorectal cancer is to cure the patient. so that's the primary goal - to cure the patient. sometimes you need to give radiotherapy and chemotherapy to colorectal cancer patients to increase the chance of cure from rectal cancer. again, if you think you don't need radiotherapy or chemotherapy for rectal cancer. if you think you can do a good total mesorectal excision surgery operation without radiation therapy or chemotherapy. then you should do it because you reduce the postoperative morbidity. you reduce complication rate and side effects of multimodality treatment of colorectal cancer. but if you have to use radiotherapy and chemotherapy in colorectal cancer treatment, you should use it. and then you have to inform the colorectal cancer patient about this. a combination of total mesorectal excision surgery with low anterior resection and anastomosis and radiotherapy with chemotherapy will result in a poor anorectal function. it may require a permanent stoma. dr. torbjorn holm, md (rectal cancer surgeon, professor, karolinska institute, stockholm): there are no patients who had tme surgical operation and chemotherapy with radiotherapy who have good anorectal function after colorectal cancer treatment. all patients have some impaired anorectal function. this has been studied very thoroughly. recently there is a study on anorectal function after colorectal surgery from denmark. they have invented the low anterior resection syndrome system (lars system). they have developed scoring system for quality of anorectal function after colorectal cancer multimodality treatment. when you score the anorectal function in a rectal cancer patient after treatment it is obvious that the majority of patients have quite poor anorectal function.
but on the other hand it's very difficult to keep good anorectal function without colostomy after extensive rectal cancer treatment with surgery and radiation therapy and chemotherapy. that's why it is so important to inform the patient. because if you inform the patient about likelihood of poor anorectal function after rectal cancer treatment, some patients may actually prefer to have the permanent colostomy placement, the stoma. colostomy in many situations is easier to manage than this lars (low anterioir resection syndrome). when patient is without colostomy, patient has to go to the toilet very often. patients without stoma have to obviously need to be aware everywhere whether the toilets are. maybe patients without stoma after rectal cancer treatment cannot go to the theater or to a dinner. because you know suddenly you have to go to the toilet very quickly. if surgeon informs the patient about this situation, some patients - at least in sweden - actually prefer to have a permanent stoma after rectal cancer treatment. it is better to have permanent colostomy than to have poor anorectal function. dr. torbjorn holm, md (rectal cancer surgeon, professor, karolinska institute, stockholm): so it is extremely important to tailor radiation therapy and chemotherapy and surgery for individual rectal cancer patient. don't use chemotherapy and radiotherapy if you don't need it. but unfortunately most patients with rectal cancer will need both surgery and radiation therapy and chemotherapy. and anorectal function after such multimodality rectal cancer treatment will not be perfect. that's just the way it is. and sometimes it's better to have permanent colostomy placement than to have a bad anorectal function after rectal cancer treatment. but the information of patients about stoma or no stoma options is crucially important.
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