Advertisement

Annals of Surgical Oncology

, Volume 18, Issue 5, pp 1397–1403 | Cite as

Impact of a Temporary Stoma on the Quality of Life of Rectal Cancer Patients Undergoing Treatment

  • Heather B. Neuman
  • Sujata Patil
  • Sarah Fuzesi
  • W. Douglas Wong
  • Martin R. Weiser
  • José G. Guillem
  • Philip B. Paty
  • Garrett M. Nash
  • Larissa K. TempleEmail author
Colorectal Cancer

Abstract

Background

Data from randomized controlled trials support use of a diverting stoma in rectal cancer patients with low anastomoses, but there is little data on how this impacts patient quality of life (QOL). This study prospectively evaluates QOL in stage I–III rectal cancer patients undergoing sphincter-preserving surgery (SPS) with a temporary diverting stoma.

Materials and Methods

Patents were identified from a prospective single-institution study of stage I–III rectal cancer patients undergoing SPS. Patients completed the EORTC C30/CR38 QOL scale preoperatively, at stoma closure, and at 6 months. The Stoma Quality of Life (SQOL) was administered at stoma closure. Subscales of the EORTC hypothesized to be affected by a diverting stoma were identified a priori. Longitudinal trends were analyzed using repeated measures ANOVA. Frequencies for responses on specific SQOL items were tabulated, and correlations between SQOL subscales and EORTC Global QOL assessed with Pearson correlation coefficient.

Results

Global QOL was reportedly good (mean score 70.2) and did not change with a temporary stoma (P = .83). Physical (P = .33), role (P = .07), and social function (P = .48) were also stable. Decreased body image was observed (P = .03). Stoma-related difficulties identified by the SQOL included sexual activity (53%), leakage (39%), discomfort in clothing (34%), concerns regarding privacy to empty pouch (32%), and feeling unattractive (31%). “Overall satisfaction with life,” Work/social function (P < .001), sexuality/body image (P = .01), and stoma function (P = .01) subscales of the SQOL correlated strongly with the EORTC Global QOL score (P < .001).

Conclusion

In this longitudinal study of QOL in rectal cancer patients with a temporary stoma, Global QOL was good despite significant stoma-related difficulties. Use of alternative research methodology is necessary to provide insight into why this contradiction exists.

Keywords

Rectal Cancer Rectal Cancer Patient Validation Population Stoma Reversal Temporary Stoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This research was funded through a Limited Project Grant from the American Society of Colon and Rectal Surgeons, and a Career Development Award from the American Society of Clinical Oncology.

References

  1. 1.
    Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, et al. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology. 2008;55:1562–7.PubMedGoogle Scholar
  2. 2.
    Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.PubMedCrossRefGoogle Scholar
  3. 3.
    Pakkastie TE, Ovaska JT, Pekkala ES, Luukkonen PE, Jarvinen HJ. A randomised study of colostomies in low colorectal anastomoses. Eur J Surg. 1997;163:929–33.PubMedGoogle Scholar
  4. 4.
    Pimentel JM, Duarte A, Gregorio C, Souto P, Patricio J. Transverse coloplasty pouch and colonic J-pouch for rectal cancer—a comparative study. Colorectal Dis. 2003;5:465–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Ulrich AB, Seiler C, Rahbari N, Weitz J, Buchler MW. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009;52:412–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Hüser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008;248:52–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96:462–72.PubMedCrossRefGoogle Scholar
  8. 8.
    Hallbook O, Sjodahl R. Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg. 1996;83:60–2.PubMedCrossRefGoogle Scholar
  9. 9.
    Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2001;88:400–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003;90:1261–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum. 2005;48:1021–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Eberhardt JM, Kiran RP, Lavery IC. The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum. 2009;52:380–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11:8–15.PubMedCrossRefGoogle Scholar
  14. 14.
    Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg. 2007;94:1548–54.PubMedCrossRefGoogle Scholar
  15. 15.
    McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92:1150–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg. 2004;240:255–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Hallbook O, Matthiessen P, Leinskold T, Nystrom PO, Sjodahl R. Safety of the temporary loop ileostomy. Colorectal Dis. 2002;4:361–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Rathnayake MM, Kumarage SK, Wijesuriya SR, Munasinghe BN, Ariyaratne MH, Deen KI. Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: a prospective clinical study. Int J Nurs Stud. 2008;45:1118–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Thalheimer A, Bueter M, Kortuem M, Thiede A, Meyer D. Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum. 2006;49:1011–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Camilleri-Brennan J, Steele RJ. Prospective analysis of quality of life after reversal of a defunctioning loop ileostomy. Colorectal Dis. 2002;4:167–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum. 2000;43:650–5.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Leary DP, Fide CJ, Foy C, Lucarotti ME. Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg. 2001;88:1216–20.PubMedCrossRefGoogle Scholar
  23. 23.
    Siassi M, Hohenberger W, Losel F, Weiss M. Quality of life and patient’s expectations after closure of a temporary stoma. Int J Colorectal Dis. 2008;23:1207–12.PubMedCrossRefGoogle Scholar
  24. 24.
    Tsunoda A, Tsunoda Y, Narita K, Watanabe M, Nakao K, Kusano M. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum. 2008;51:218–22.PubMedCrossRefGoogle Scholar
  25. 25.
    Yau T, Watkins D, Cunningham D, Barbachano Y, Chau I, Chong G. Longitudinal assessment of quality of life in rectal cancer patients with or without stomas following primary resection. Dis Colon Rectum. 2009;52:669–77.PubMedCrossRefGoogle Scholar
  26. 26.
    Temple LK, Romanus D, Niland J, Veer AT, Weiser MR, Skibber J, et al. Factors associated with sphincter-preserving surgery for rectal cancer at national comprehensive cancer network centers. Ann Surg. 2009;250:260–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Ricciardi R, Virnig BA, Madoff RD, Rothenberger DA, Baxter NN. The status of radical proctectomy and sphincter-sparing surgery in the United States. Dis Colon Rectum. 2007;50:1119–27 (discussion 26–7).PubMedCrossRefGoogle Scholar
  28. 28.
    Paquette IM, Kemp JA, Finlayson SR. Patient and hospital factors associated with use of sphincter-sparing surgery for rectal cancer. Dis Colon Rectum. 2010;53:115–20.PubMedCrossRefGoogle Scholar
  29. 29.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.PubMedCrossRefGoogle Scholar
  30. 30.
    Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer. 1999;35:238–47.PubMedCrossRefGoogle Scholar
  31. 31.
    Baxter NN, Novotny PJ, Jacobson T, Maidl LJ, Sloan J, Young-Fadok TM. A stoma quality of life scale. Dis Colon Rectum. 2006;49:205–12.PubMedCrossRefGoogle Scholar
  32. 32.
    Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16:139–44.PubMedGoogle Scholar
  33. 33.
    Schwarz R, Hinz A. Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer. 2001;37:1345–51.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Heather B. Neuman
    • 1
  • Sujata Patil
    • 2
  • Sarah Fuzesi
    • 2
  • W. Douglas Wong
    • 2
  • Martin R. Weiser
    • 2
  • José G. Guillem
    • 2
  • Philip B. Paty
    • 2
  • Garrett M. Nash
    • 2
  • Larissa K. Temple
    • 2
    Email author
  1. 1.University of WisconsinMadisonUSA
  2. 2.Memorial Sloan-Kettering Cancer CenterNew YorkUSA

Personalised recommendations