Quality of life after extended lymph node dissection for colon cancer

Aim: to evaluate the effect of the lymphadenectomy (LD) level on the quality of life (QoL) in patients who underwent laparoscopic colon resection for colon cancer.

Patients and methods: the study included 86 patients who underwent surgery for colon cancer from January 2018 to August 2020. The patients were randomized in 2 groups: the main group — with D3 lymphadenectomy — 41 patients and the control group — with D2 — 45 patients. Two validated QoL questionnaires (QLQ-C30 v. 3.0, QLQ-CR29 v. 2.1) of the European Organization for Research and Treatment of Cancer (EORTC) were applied by the patients on the day before the surgery and on the 30th day after the surgery and were used for the further analysis.

Results: there were no significant differences between the groups in gender, age, weight, height, BMI, assessment of functional and physical status according to the ASA and ECOG scales, incidence of comorbidities, tumor site, type and volume surgical of procedures. Regardless of the level of lymphadenectomy, the significant improvement in QoL after surgery was obtained (pQoLD3 = 0.005, pQoLD2 = 0.023) in both groups. The significant increase in the incidence of diarrhea by 2.65 times was detected after laparoscopic right hemicolectomies with extended lymphadenectomy (p = 0.042). Also, there was a significant 2.45 fold increase in the risk of developing erectile dysfunction (ED) after D3 lymphadenectomy in the patients who underwent laparoscopic resections of the left colon in the early postoperative period (p = 0.031).

Conclusion: the analysis of physical, social functioning and symptomatic scales has established that in patients who underwent colon resection for cancer of the left colon erectile dysfunction occurred to a greater extent after D3 LD, whereas diarrhea was more likely to develop after resection of the right colon with D3 LD than with D2 LD.

1. O’Boyle CA. Assessment of quality of life in surgery. British Journal of Surgery. 1992;79(5):395–398. DOI: 10.1002/bjs.1800790506

2. Bower JE, Bak K, Berger A. et al. Screening, Assessment, and Management of Fatigue in Adult Survivors of Cancer: An American Society of Clinical Oncology Clinical Practice Guideline Adaptation. Journal of Clinical Oncology. 2014;32(17):1840–1850. DOI: 10.1200/JCO.2013.53.4495

3. Cella D. Quality-of-life measurement in oncology. Psychosocial interventions for cancer. 2001;57–76. DOI: 10.1037/10402-004

4. Shelygin Yu.A., Achkasov S.I., Sushkov О.I. et al. Short-term results of right-sided hemicolectomy performed by different laparoscopic techniques in patients with right sided colon cancer. Endoscopic surgery. 2014;20(5):3–7 (in Russ.).

5. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–150.

6. Bonjer HJ, Deijen CL, Abis GA. et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. The new England Journal of Medicine. 2015;29(2):334–48. DOI: 10.1056/nejmc1505367

7. Karachun A.M., Petrova E.A., Sinenchenko G.I. et al. Comparative analysis of quality of life after laparoscopic and open procedures for upper and middle rectal cance. Colorectal Oncology. 2018;8(1):28–32. (in Russ.). DOI: 10.17650/2220-3478-2018-8-1-28-33

8. Karachun A., Petrov A., Panaiotti L. et al. Protocol for a multicentre randomized clinical trial comparing oncological outcomes of D2 versus D3 lymph node dissection in colonic cancer (COLD trial). BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. 2019;(3):288–298. DOI: 10.1002/bjs5.50142

9. Kitano S, Inomata M, Mizusawa J. et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomized controlled trial. The Lancet Gastroenterology & Hepatology. 2017;4(2):261–268. DOI: 10.1016/S2468-1253(16)30207-2

10. Liang JT, Huang KC, Lai HS. et al. Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Annals of surgical oncology. 2007;7(14):1980–1990. DOI: 10.1245/s10434-007-9368-x

11. Greene FL, Balch CM, Fleming ID. et al. AJCC cancer staging handbook: TNM classification of malignant tumors. Springer Science & Business Media. 2002.

12. Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population- based to a more “personalized” approach to cancer staging. CA: a cancer journal for clinicians. 2017;67:93–99. DOI: 10.3322/caac.21388

13. Watanabe T, Muro K, Ajioka Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. International journal of clinical oncology. 2018;1(23):1–34. DOI: 10.1007/s10147-017-1101-6

14. Aaronson NK, Ahmedzai S, Bergman B. et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-

15. of-life instrument for use in international clinical trials in oncol ogy. JNCI: Journal of the National Cancer Institute. 1993;5(85):365–376. DOI: 10.1093/jnci/85.5.365

16. Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. American Journal of Gastroenterology. 2016;5(111):602–622. DOI: 10.1038/ajg.2016.126

17. Ivashkin V.T., Mayev I.V., Sheptulin A.A. et al. Diagnosis and treatment of the functional dyspepsia: clinical guidelines of the Russian Gastroenterological Association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(1):50–61. (in Russ.). DOI: 10.22416/1382-4376-2017-27-1-50-61

18. National Cancer Institute Cancer Therapy Evaluation Program: Responsible Adverse Event (AE) Reporting: Finding Appropriate AE Terms [database online]. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/CTC.htm. Accessed November 8, 2018;3.

19. Whistance RN, Conroy T, Chie W. et al. Clinical and Psychometric Validation of the EORTC QLQ-CR29 Questionnaire Module to Assess Health-Related Quality of Life in Patients with Colorectal Cancer. European journal of cancer. 2009;45(17):3017–3026. DOI: 10.1016/j.ejca.2009.08.014

20. Thorsen Y, Stimec B, Andersen SN, et al. Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy. Techniques in Coloproctology. 2016;20(7):445–453. DOI: 10.1007/s10151-016-1466-y

21. Ohigashi S, Hoshino Y, Ohde S, et al. Functional outcome, quality of life, and efficacy of probiotics in postoperative patients with colorectal cancer. Surgery today. 2011;9(41):1200–1206. DOI: 10.1007/s00595-010-4450-6