Late assessment of quality of life in patients with rectal carcinoma: comparison between sphincter preservation and definitive colostomy

Abstract

PurposePatients with cancer of the lower and middle rectum who are candidates for curative surgery often have negative opinions on definitive colostomy. The purpose of this study is to compare the quality of life (QoL) of patients who undergo standard treatment for rectal cancer with sphincter preservation or definitive colostomy.MethodsA total of 125 patients with adenocarcinoma of the lower or middle rectum who underwent radical surgery with curative intent with a follow-up ≥ 1 year were recruited: 83 patients (group 1) were subjected to low anterior resection and low colorectal or coloanal anastomosis—thus preserving their sphincter—and 42 (group 2) were treated with abdominoperineal resection, followed by terminal definitive colostomy. QoL was assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires.ResultsHealth and global quality of life were similar between groups; however, patients who underwent definitive colostomy had higher scores on the emotional (p value = 0.016) and cognitive function scales (p value = 0.017). Patients with sphincter preservation presented with more symptoms that were related to stool frequency (p value < 0.001), intestinal constipation (p value = 0.005), fecal incontinence (p value = 0.001), buttock pain (p value = 0.023), and nausea and vomiting (p value = 0.036), whereas patients with permanent colostomy had higher scores for dysuria (p value = 0.033).ConclusionAlthough global QoL scores did not differ between groups, patients who underwent definitive colostomy had significantly better functional and symptom scale scores, reflecting greater function with fewer symptoms.Electronic supplementary materialThe online version of this article (10.1007/s00384-018-3044-4) contains supplementary material, which is available to authorized users.

Management guidelines for low anterior resection syndrome – the MANUEL project

“…Information must include advantages (no urgency, no incontinence, no anal pain) and disadvantages (parastomal hernia, prolapse, dermatitis, leakage). The information material must include the evidence of similar (and even increased) HRQoL scores of patients with stoma when compared with patients who developed complications after sphincter‐preserving surgery [76,77]; however, patients should be aware that, until now, there is no evidence of a change in HRQoL in patients who undergo stoma formation due to refractory LARS.…”

“…Stoma formation can be proposed to patients with severe LARS with refractory symptoms and impaired HRQoL as a final treat- complications after sphincter-preserving surgery [76,77]; however, patients should be aware that, until now, there is no evidence of a change in HRQoL in patients who undergo stoma formation due to refractory LARS.…”

“…Therefore, successful application of TAI is strongly related to an intensive counselling, hands-on training and continuous support from an experienced medical staff. A positive compliance with this treatment is mainly dependent on the presence and aid of specially trained stoma/incontinence therapists who can instruct and accompany patients [65,66,76,77].…”

Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer

“…In a study conducted by Silva et al , [ 43 ] 125 patients diagnosed with mid and low rectal adenocarcinoma, 83 patients underwent LAR with low colorectal or coloanal anastomosis, while 42 patients were treated with APR and terminal colostomy. Upon assessment the QoL scores in both groups, the patients who underwent APR had significantly better function and symptom scores reflecting better QoL.…”

“…While other studies, pointed out that the QoL after ISR is not better than QoL after APR because of the incontinence state which hinders the patient from doing daily activity and leads to social isolation. [ 43 ]…”