Patients' preferences for low rectal cancer surgery

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Patient-Reported Outcomes

Background:

• Rectal cancer treatment involves surgical options like low anterior resection (LAR) and abdominoperineal resection (APR).
• Patient preferences and perceived outcomes significantly influence treatment decisions.
• Understanding patient trade-offs between surgical risks and quality of life is essential.

Purpose of the Study:

• To determine patient preferences between LAR and APR based on their experiences.
• To assess patient willingness to accept risks like incontinence versus the need for a stoma.
• To inform future treatment decisions for resectable rectal cancer.

Main Methods:

• Interviewed 122 patients with prior LAR or APR experience.
• Utilized a treatment trade-off method comparing stoma certainty against incontinence risk.
• Employed a time trade-off method assessing life expectancy given stoma or incontinence.

Main Results:

• LAR patients accepted higher incontinence risks to avoid APR compared to APR patients.
• 71% of LAR patients chose LAR even with certain monthly incontinence; 32% chose LAR with daily incontinence.
• APR patients were willing to forgo less life expectancy to avoid a stoma than LAR patients were to avoid monthly incontinence.

Conclusions:

• The majority of patients favored LAR over APR, accepting potential fecal incontinence.
• LAR is often preferred when surgically feasible, but patient education is paramount.
• Comprehensive pre-operative counseling on surgical options and outcomes is recommended for all rectal cancer patients.