QUALITY-OF-LIFE IN COLORECTAL-CANCER - STOMA VS NONSTOMA PATIENTS

PURPOSE: The bowel and sexual function of colorectal cancer patients u ndergoing either sphincter-saving or sphincter-sacrificing surgical pr ocedures may be impaired. A legitimate question is how these different surgical techniques affect the patients' quality of life. METHODS: Se venteen studies were identified that compared at least one of four asp ects of patient functioning (i.e., physical, psychologic, social, and sexual) between stoma patients and nonstoma patients. RESULTS: Althoug h the literature does not yield entirely consistent findings, some lon g-term effects of surgery can be identified: 1) both patient groups ar e troubled by frequent or irregular bowel movements and diarrhea; 2) s toma patients report higher levels of psychologic distress than do non stoma patients; 3) although both stoma patients and nonstoma patients report restrictions in their level of social functioning, such problem s are more prevalent among patients With a colostomy; 4) sexual functi oning of male and female stoma patients is consistently more impaired than that of male and female patients with intact sphincters. Results of the current review were compared with those of other, related areas . CONCLUSIONS: Although nonstoma patients generally fare better than d o stoma patients, they also suffer from physical impairments induced b y sphincter-saving procedures (e.g., impaired bowel and sexual functio n). These impairments may become more prevalent as ultralow anastomosi s is more frequently applied, resulting in bowel and sexual dysfunctio n and related psychologic distress. Well-designed studies are needed t hat examine whether quality-of-life benefits are to be gained by use o f ultralow anastomosis compared with colostomy.