Brazilian Patients Submitted to Abdominoperineal Resection and Definitive Abdominal Colostomy Have Low Quality of Life and Self-Esteem

Abstract

Surgical treatment of low anorectal cancer (LARC) often requires abdominoperineal resection (APR) with definitive abdominal colostomy (AC). Individuals with this condition are obliged to face numerous challenges associated with definitive AC and to adapt to far-reaching changes in their normal routine. The aim of our study was to test the hypothesis that individuals with definitive AC have reduced quality of life (QoL) and lowered self-esteem. We analyzed the responses to Flanagan QoL Scale (FQLS; maximum total score = 112) and Rosenberg Self-Esteem Scale (RSES; maximum total score = 40) questionnaires by LARC patients who had been submitted to APR/AC (case group; n = 65) and patients with colorectal cancer who had received colectomy with primary anastomosis without AC (control group: n = 65). The mean total scores of the case group in FQLS and RSES questionnaires (73.5 and 27.8, respectively) were significantly lower (P < 0.001) than those of the control group (85.9 and 30.3, respectively). Multivariate analysis of the case group scores revealed that the state of being retired was strongly associated with poor QoL while low educational level, unemployment, and chemotherapy were strongly associated with low self-esteem. Colorectal cancer patients with definitive AC had poorer QoL and lower self-esteem than those without AC and continued to struggle with their changed situation at six months or longer after surgery. Our findings indicate that patients need even more pre- and post-operative assistance from healthcare providers to enable them and their families to cope with ostomy-related problems.