Dp. O'Leary et al., Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma, BR J SURG, 88(9), 2001, pp. 1216-1220
Background: Low anterior resection (LAR) with total mesorectal excision (TM
E) may be the optimal operation for carcinoma of the mid or lower rectum. R
outine formation of a temporary defunctioning stoma has been recommended wi
th TME. The impact of this strategy on health-related quality of fife (HRQO
L) has not been addressed.
Methods: A prospective longitudinal study was conducted among 24 patients u
ndergoing LAR with TME and loop ileostomy for rectal cancer. Clinical outco
mes were documented. HRQOL was assessed using Short Form 36 (SF-36). Twenty
-three patients undergoing high anterior resection (HAR) for rectosigmoid c
ancer were studied concurrently to determine the effects of major colorecta
l 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 l
oop ileostomy. Twelve weeks after HAR SF-36 scores were stable or improved
compared with preoperative levels. In contrast, 12 weeks after LAR + TME pa
tients had a reduction in physical functioning scores on SF-36. SF-36 score
s improved after ileostomy closure. Ileostomy closure increased total hospi
tal stay and time off non-work activities.
Conclusion: LAR with TME and temporary loop ileostomy for rectal cancer res
ults in a long total hospital stay and impairs aspects of HRQOL. Prompt sto
ma closure should be a priority in these patients.