Health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: a prospective 6-month follow-up study

Abstract

This longitudinal descriptive study examined whether rectal cancer patients report changes in health-related quality of life (HRQOL) over a 6-month period after different types of sphincter-saving surgery (SSS): intersphincteric resection (ISR), ultra-low anterior resection (ULAR) and low anterior resection (LAR). It also compares HRQOL among the three groups of patients. Seventy-three patients from two hospitals in Japan completed questionnaires on HRQOL and defecation symptoms immediately before surgery and 1 and 6 months afterwards. Results showed that ISR patients had significantly worse HRQOL scores than ULAR and LAR patients and more defecation symptoms that persisted during the 6 months post-SSS. Thus, patients undergoing ISR require psychological and social support, including skills in competent self-management, during the early post-operative period. Furthermore, defecation problems substantially influence HRQOL. The first month post-SSS is particularly challenging. The assumption that HRQOL is better after SSS compared to living with a permanent stoma might not be valid.

Risk factors of stoma re-creation after closure of diverting ileostomy in patients with rectal cancer who underwent low anterior resection or intersphincteric resection with loop ileostomy

“…In patients with rectal cancer, sphincter-saving surgeries are increasing because of the improvement of the end-to-end anastomosis stapling devices, preoperative chemo-radiation therapy, and similar oncological outcomes to abdominoperineal resections (APR) [ 1 2 3 4 5 ]. However, anastomotic leakage is the most unfavorable complication of sphincter-saving surgery because it is related with poor clinical outcomes, such as early postoperative morbidity and mortality [ 6 7 8 ].…”

“…Furthermore, diverting stomas are usually performed i n ISR because of the concern regarding anal dysfunction [ 11 12 ]. However, stomas negatively influence the patients' quality of life [ 2 4 13 14 15 16 ]; hence, most of the stomas are thought to be temporary. Most of the patients may undergo reversal surgery, but some of them should experience stoma re-creation.…”

The quality of life in colorectal cancer patients: a mixed-methods study

“…The problems experienced by patients have an adverse effect on their social and daily life activities, and their quality of life is thereby diminished. In addition, in patients with stoma, body image may be altered, and psychological problems such as anxiety and depression, and physiological problems such as excess gas, odor, and skin irritations, may occur (Brown, 2017;Kinoshita et al, 2017;Taylor & Morgan, 2011).…”

Predictors of Quality of Life and Social Support as a Mediator between Defecation Function and Quality of Life among Rectal Cancer Patients

“…Recent advances in treatment technology have resulted in improved survival of patients with colorectal cancer, and their Quality of Life (QoL) is an increasingly important aspect of long-term care for chronic illness. Approximately 80% of patients with rectal cancer undergo sphincter-saving surgery; the ultimate goal of this surgical procedure is to minimize complications through radical resection, thereby preserving the anal sphincter muscle and improving QoL [3].…”

“…However, a systematic review reported that colorectal cancer patients expressed diverse unmet needs after surgery, encompassing emotional support, information about diet and long-term self-management of symptoms, and complications at home [14]. They also experienced a lack of supportive care after discharge and wanted counseling received from healthcare professionals during the preoperative period to extend to the postoperative period, including instructions on the use of self-management skills for their functional complaints or symptoms [3,15]. The information needs of patients can be met by providing social support in the form of counseling and education by nurses; such psychological interventions can help them overcome post-surgical symptoms and successfully cope with the disease, thereby improving their QoL [12].…”