title: Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma.
abstract: 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 ileostomy closure. Ileostomy closure increased total hospital stay and time off non-work activities.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Gloucestershire Royal Hospital, Gloucester, UK. doleary@doctors.org.uk
authors.forename: D P
authors.initials: DP
authors.lastname: O'Leary
authors.forename: C J
authors.initials: CJ
authors.lastname: Fide
authors.forename: C
authors.initials: C
authors.lastname: Foy
authors.forename: M E
authors.initials: ME
authors.lastname: Lucarotti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D012811:Sigmoid Neoplasms / Q000601:surgery*; D016896:Treatment Outcome