Evaluating the functional effects, morbidity, recurrence, survival and quality of life after curative treatment for rectal cancer

Treatment for rectal cancer can be associated with rectal functional impairment,increased morbidity and may impact quality of life. Restorative surgery is the preferredchoice of surgery, but in some circumstances, surgery with a permanent stoma is requiredto ensure tumour clearance. While the aim of treatment for rectal cancer is to ensure curewhere possible the long term impact of the functional impact of this treatment is notknown.This thesis investigates rectal functional impairment after treatment for rectal cancerin the long-term and its impact on quality of life in rectal cancer compared with agematched colon cancer patients. It also assesses the impact of radiotherapy on thisimpairment and its effect on quality of life in rectal cancer. In addition, it compares thequality of life in patients with and without a primary stoma after curative surgery forcolorectal cancer and determines the impact of country of birth on the perception of astoma. This thesis finally examines the long term morbidity, local recurrence and survivalassociated with radiotherapy and provides a protocol for future studies to better evaluatethe effects of rectal cancer treatment.Patients treated for rectal cancer have greater rectal functional impairment comparedto patients treated for colon cancer. In patients treated for rectal cancer, those receivingradiotherapy had even greater rectal dysfunction. This high rate of rectal dysfunction didnot impact on the global quality of life. Patients with a permanent stoma had morerestricted physical activity those without a stoma but there were no differences in mentalfunctioning. There were no differences in the overall quality of life associated withcountry of birth. In this cohort of patients there was no difference in morbidity betweenthose patients who had surgery alone compared with those who had radiotherapy andsurgery. The rates of local and distant recurrence were not different between the groupsas was overall survival.This thesis has shown that the functional outcomes after treatment for rectal cancershould be an important factor in decision making and that the role of radiotherapy in thetreatment of rectal cancer should be re-evaluated