Questionnaire to Survey Cosmetic Outcomes in Laparoscopic Surgery for Colorectal Cancer

Abstract

Background and objectives: There has been a steady increase in the use of minimally invasive surgery, including conventional multiport laparoscopic surgery (MLS) and single-site laparoscopic surgery (SLS) for colorectal cancer. We aimed to evaluate how important the cosmetic outcome, one of the advantages of SLS, is to patients and whether SLS reflects social needs.

Methods: We used a web-based questionnaire to survey nonmedical and medical workers for what factors were considered on the assumption that respondents undergo colorectal cancer surgery and that the most important person for them undergoes. Five items (curability, safety, pain, length of hospital stay, and cosmetic outcomes) were compared. After paired photographs before and after SLS and MLS were shown, perceptions of body image and cosmesis were assessed using a visual analog scale.

Results: This study included a total of 1352 respondents (990 nonmedical and 362 medical). Curability had the highest score (49.9-53.7 points), followed by safety (23.8-24.7 points). The scores for cosmetic outcomes (6.2-7.1 points) were almost equal to those of the length of hospital stay (6.2-7.1 points), which was associated with medical costs and pain (10.0-11.1 points), one of the main reasons for fear of surgery. Participants who were female, younger, and in the nonmedical group placed great importance on cosmetic outcomes. For all questions regarding body image and cosmesis, SLS had superior scores compared with MLS.

Conclusions: Understandably, curability, and safety were most important in colorectal cancer surgery. However, medical workers should consider cosmetic outcomes, even in malignant cases.

Keywords: colorectal cancer; conventional multiport laparoscopic surgery; cosmetic outcomes; single-site laparoscopic surgery.

FIGURE 1.

Importance of each outcome in colorectal cancer surgery. Representative photos used in the questionnaire before (A) and after (B) multiport laparoscopic surgery and before (C) and after (D) single-site laparoscopic surgery for colorectal cancer. (E) Respondents scored what factors are considered on the assumption that respondents (white bars) and the most important person for respondents (black bars) undergo surgery. Total scores summed to 100 points. (F) Differences between the scores given by females and males with 95% CI for each outcome. The difference was evaluated by the Student’s t test.^★★P < 0.01; NS, not significant.

FIGURE 2.

Importance of each outcome according to sex (A and B), the age of respondents (C and D), and their occupation (E and F). Respondents scored the importance of each outcome (sum = 100 points). Panels A, C, and E represent what factors are considered when respondents undergo surgery and B, D, and F represent what factors are considered when the most important person for respondents undergoes surgery. The difference was evaluated by the Student’s t test. ^★P < 0.05; ^★★P < 0.01; NS, not significant.

FIGURE 3.

The relevance of the age of the respondents to the importance of curability (A1 and A2), safety (B1 and B2), pain (C1 and C2), length of hospital stay (D1 and D2), and cosmetic outcomes (E1 and E2). Panels (A1–E1) represent the scores for the outcomes when respondents undergo surgery and (A2–E2) represent the scores for the outcomes when the most important person for respondents undergoes surgery. The relation between age and the importance of each outcome was calculated using Spearman’s rank correlation coefficient.

FIGURE 4.

Questionnaire regarding perceptions of body image and cosmesis. (A) Result from the question “Which age group is suitable for single-site laparoscopic surgery?” We scored the sample as follows: most suitable scored 5, 2nd suitable scored 4, 3rd suitable scored 3, 4th suitable scored 2, and 5th suitable scored 1. The plotted numbers were obtained by summing these scores. (B) Question: Does the wound worry you if it is yours? (C) Question: Are you less satisfied with your body if the wound is yours? (D) Question: Is it difficult to look at yourself naked if the wound is yours? (E) Question: Do you feel less attractive as a result of the operation if the wound is yours? (F) Question: Do you think the operation has damaged your body if the wound is yours? A visual analog scale (0–10) was used for these questions. The right side figures show the mean ± SE of the scales. The difference was evaluated by the Student’s t test. ^★★P < 0.01.