Abstract
BackgroundRectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery.MethodsIn total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment of RC at our colorectal surgery department between January 2013 and January 2015 were enrolled. Surgical methods, tumor distance from the anal margin (TD), anastomosis distance from the anal margin (AD) and complications were compered between the non-ostomy and ostomy surgery groups. QOL was compared between the two groups at years 2, 3, and 4 after surgery. The Wexner score and the validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) questionnaire scores were assessed for all patients in January 2017. SPSS 21.0 was utilized for all data analyses.ResultsSurgical methods, TD, and AD significantly differed between the non-ostomy and ostomy surgery groups (all P < .001). However, no differences were found in the number of complications between the groups (P = .483). For the 192 patients undergoing Dixon surgery, role function (RF), global QOL (GQOL), sleep disturbance, and the incidence of constipation showed significant differences between the two groups (P = .012, P = .025, P = .036, and P = .015, respectively). In the 31 cases of permanent ostomy, we observed significant differences in GQOL scores, dyspnea incidence, and financial difficulties across the different years (P = .002, P = .036, and P < .01, respectively). Across all 223 cases, there were significant differences in social function and GQOL scores in the second year after surgery (P = .014 and P < .001, respectively). However, no differences were observed in the other indices across the three time-points.ConclusionsRC patients undergoing ostomy surgery, especially those with low and super-low RC, revealed poorer defecation function and QOL in the present study. However, 2 years after surgery, most of the defecation and QOL indicators showed recovery.
Highlights
Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function
No statistical differences were noted between the ostomy and non-ostomy surgery groups in terms of sex, age, preoperative C-reactive protein (CRP) level, maximum tumor diameter, bowel resection length, laparoscopic surgery, and chemotherapy (P = .192, P = .286, P = .100, P = .903, P = .873, P = .100, P = .192, respectively)
The number and percentage of counting data and the mean and standard deviation of the clinicopathological data were evaluated in both groups
Summary
Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) of patients, in terms of bowel and sexual function [1, 2]. There has been an increase in the use of preventive ostomy surgery following rectal surgery. This has led to concerns pertaining to defecation function and QOL. The differences in outcome between those who undergo an ostomy surgery (including preventive and permanent ostomy surgery) and those who do not, in terms of defecation function and QOL are still uncertain
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