Abstract
Treatment for rectal cancer can be associated with rectal functional impairment,
increased morbidity and may impact quality of life. Restorative surgery is the preferred
choice of surgery, but in some circumstances, surgery with a permanent stoma is required
to ensure tumour clearance. While the aim of treatment for rectal cancer is to ensure cure
where possible the long term impact of the functional impact of this treatment is not
known.
This thesis investigates rectal functional impairment after treatment for rectal cancer
in the long-term and its impact on quality of life in rectal cancer compared with age
matched colon cancer patients. It also assesses the impact of radiotherapy on this
impairment and its effect on quality of life in rectal cancer. In addition, it compares the
quality of life in patients with and without a primary stoma after curative surgery for
colorectal cancer and determines the impact of country of birth on the perception of a
stoma. This thesis finally examines the long term morbidity, local recurrence and survival
associated with radiotherapy and provides a protocol for future studies to better evaluate
the effects of rectal cancer treatment.
Patients treated for rectal cancer have greater rectal functional impairment compared
to patients treated for colon cancer. In patients treated for rectal cancer, those receiving
radiotherapy had even greater rectal dysfunction. This high rate of rectal dysfunction did
not impact on the global quality of life. Patients with a permanent stoma had more
restricted physical activity those without a stoma but there were no differences in mental
functioning. There were no differences in the overall quality of life associated with
country of birth. In this cohort of patients there was no difference in morbidity between
those patients who had surgery alone compared with those who had radiotherapy and
surgery. The rates of local and distant recurrence were not different between the groups
as was overall survival.
This thesis has shown that the functional outcomes after treatment for rectal cancer
should be an important factor in decision making and that the role of radiotherapy in the
treatment of rectal cancer should be re-evaluated.