[The quality of life after extirpation of the rectum for carcinoma]

Abstract

Basic problem and aim of study: The quality of life for patients who have undergone total rectal resection for carcinoma is impaired by the artificial intestinal stoma. Their psychosocial disorders were analysed in relation to the method of looking after the stoma (with or without controlled stool emptying by intestinal irrigation) and compared with patients who had a after continence-preserving operation for rectal carcinoma.

Patients and methods: Of the 205 patients (aged 58.6 +/- 8.1 years; 72 women and 133 men) 78 had a continence resection (group 1), 127 had a colostomy (irrigation in 81, group 2a; merely looking after the colostomy bag in 46, group 2b). Their personality characteristics were tested prospectively with the State-Trait Anxiety Inventory (STAI) and quality of life parameters with a standardized questionnaire.

Results: While personality traits were similar, significantly fewer patients in group 2a complained about disturbances of self esteem (32.9 vs 60.0%; P < 0.01), and had pessimistic future expectations (20.5 vs 46.5; P < 0.01) than those in group 2b. There was no significant difference in these two parameters between groups 1 and 2a. The irrigation procedure was taught to 60.5% of patients during their hospital stay. Accepting irrigation was more common when rehabilitation was begun early rather than delayed (72.9 vs 42.9%; P < 0.01). Disturbances of erection occurred in 69.9% of men younger than 60 years after the operation.

Conclusions: Compared with conventional bag care, regular irrigation improves the quality of life for patients with a colostomy. Postoperatively disordered erection is an independent risk factor for any abnormal self esteem and depression. They should be stressed more during history taking and therapeutically.