Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

Abstract

Background Surgical resection is the mainstay of curative treatment for rectal cancer. Post-operative complications, low anterior resection syndrome (LARS), and the presence of a stoma may influence the quality of life after surgery. This study aimed to gain more insights into the long-term trade-off between stoma and anastomosis. Methods All patients who underwent sphincter-sparing surgical resection for rectal cancer in the Leiden University Medical Center and the Reinier de Graaf Gasthuis between January 2012 and January 2016 were included. Patients received the following questionnaires: EORTC-QLQ-CR29, EORTC-QLQ-C30, EQ-5D-5L, and the LARS score. A comparison was made between patients with a stoma and without a stoma after follow-up. Results Some 210 patients were included of which 149 returned the questionnaires (70.9%), after a mean follow-up of 3.69 years. Overall quality of life was not significantly different in patients with and without stoma after follow-up using the EORTC-QLQ-C30 (p = 0.15) or EQ-5D-5L (p = 0.28). However, after multivariate analysis, a significant difference was found for the presence of a stoma on global health status (p = 0.01) and physical functioning (p < 0.01). Additionally, there was no difference detected in the quality of life between patients with major LARS or a stoma. Conclusion This study shows that after correction for possible confounders, a stoma is associated with lower global health status and physical functioning. However, no differences were found in health-related quality of life between patients with major LARS and patients with a stoma. This suggests that the choice between stoma and anastomosis is mainly preferential and that shared decision-making is required.

Patient perspectives on consequences of resection for colorectal cancer: A qualitative study

“…However, the LARS score was not formally measured in this study [25,26]. It has been shown that quality of life in patients reporting LARS is significantly impaired [27,28]. Patients with a stoma also reported specific stoma-related challenges, such as worrying about stool leakages and uncontrollable flatulence, which is consistent with previous literature [29].…”

“…Furthermore, as shown in this study, some patients reported that good preoperative education on the consequences of colorectal cancer treatment is important to them. Explicit patient consideration of their treatment and certain trade‐offs are shown to have a positive effect on long‐term quality of life, as it leads to increased acceptance of treatment consequences [14, 27]. As shown in this study, after colorectal cancer treatment, patients face several treatment‐related health deficits in various domains (e.g., psychological, social, physical) [22].…”

Computed tomography‐based preoperative muscle measurements as prognostic factors for anastomotic leakage following oncological sigmoid and rectal resections

“…An important dilemma in patients undergoing sigmoid or rectal resection is whether or not to construct an anastomosis and/or (temporary) stoma. 33 An important consideration is the risk of anastomotic leakage since a (temporary) diverting stoma can reduce the rate of clinical symptomatic anastomotic leakage. 6,34 Furthermore, measuring a low muscle mass on the preoperative CE-CT could be an indication for prehabilitation programs, since low muscle mass may be reversible.…”

“…Accurate prediction of postoperative complications and especially anastomotic leakage could improve preoperative patient selection, treatment decision and shared‐decision making. An important dilemma in patients undergoing sigmoid or rectal resection is whether or not to construct an anastomosis and/or (temporary) stoma 33 . An important consideration is the risk of anastomotic leakage since a (temporary) diverting stoma can reduce the rate of clinical symptomatic anastomotic leakage 6,34 .…”

Low anterior resection syndrome

“…54,55 Finally, permanent stoma might be inevitable after failure of every effort, and could improve the quality of life. 56,57 Sometimes patients who suffer from the severe symptoms of LARS strongly ask the surgeon to make the permanent stoma first. The specific care for stoma can have advantages for hygienic problems and be preferred to a devastating daily life from the frequent and urgent bowel movements or fecal incontinence with painful perianal skin irritation.…”