Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma

O'Leary, D. P.
Fide, C. J.
Foy, C.
Lucarotti, M. E.

Department of Surgery, Gloucestershire Royal Hospital and *Gloucestershire Research and Development Group, Gloucestershire Health Authority, Gloucester, UK

Correspondence to: Mr D. P. O'Leary, Department of Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK (e-mail: [email protected])

Based on a presentation to the Association of Coloproctology of Great Britain and Ireland, Jersey, Channel Islands, June 1998

Paper accepted 8 May 2001

British Journal of Surgery 88(9):p 1216-1220, September 2001.

Background:

Low anterior resection (LAR) with total mesorectal excision (TME) may be the optimal operation for carcinoma of the mid or lower rectum. Routine formation of a temporary defunctioning stoma has been recommended with TME. The impact of this strategy on health-related quality of life (HRQOL) has not been addressed.

Methods:

A prospective longitudinal study was conducted among 24 patients undergoing LAR with TME and loop ileostomy for rectal cancer. Clinical outcomes were documented. HRQOL was assessed using Short Form 36 (SF-36). Twenty-three patients undergoing high anterior resection (HAR) for rectosigmoid cancer were studied concurrently to determine the effects of major colorectal resection without a stoma.

Results:

Time to resume normal diet, length of stay in hospital and time to return to non-work activities were similar after HAR or LAR with TME and loop ileostomy. Twelve weeks after HAR SF-36 scores were stable or improved compared with preoperative levels. In contrast, 12 weeks after LAR + TME patients had a reduction in physical functioning scores on SF-36. SF-36 scores improved after ilcostomy closure. Ileostomy closure increased total hospital stay and time off non-work activities.

Conclusion:

LAR with TME and temporary loop ileostomy for rectal cancer results in a long total hospital stay and impairs aspects of HRQOL. Prompt stoma closure should be a priority in these patients.