Prospective evaluation of health-related quality of life after laparoscopic colectomy for cancer.
BACKGROUND
The aim of the present study was to prospectively determine health-related quality of life (HRQoL) changes and affecting factors after elective laparoscopic colectomy for cancer.


METHODS
The SF-36, EORTC QLQ-C30 and QLQ-CR29, and Gastrointestinal Quality of life Index (GIQLI) were used to assess 85 patients preoperatively and at 1, 3, 6, and 12 months.


RESULTS
An initial drop form baseline values was observed in 3 of 8 SF-36 domains, 3 of 5 QLQ-C30 functional scales and 1 of 5 GIQLI subscales. Emotional functioning (EF) was better postoperatively even from the first month (p = 0.03). Most functional domains were improved compared to baseline. The statistically significant changes (p < 0.05) were in the SF-36: general health (GH) (3 months), physical function (PF) (12 months) and role limitations due to emotional problems (12 months); in the QLQ-C30: EF (12 months); in the GIQLI: the global score and PF at 12 months and EF (3, 6, 12 months). From the first month after surgery, most QLQ-C30 "symptom" items were better than baseline. QLQ-CR29 "anxiety" and the "defecation problems" scales were significantly better than baseline at 1, 12 and at 6, 12 months (p < 0.05). Advanced stage (III) and chemotherapy were linked to worse EF, social function (SF), GH and global quality of life (QOL) at 3 and 6 months (p < 0.01). Males appeared to have a worse HRQoL than females at 3 and 6 months, and in 5 of 8 SF-36 domains and 3 of 5 GIQLI subscales at 12 months (p < 0.05). According to the QLQ-CR29, rectal surgery was associated more often with "impotence," "stoma problems" and "incontinence" up to 6 months, and ostomies with "embarrassment" and "stoma problems" (p < 0.05).


CONCLUSIONS
HRQoL generally improved over the first year after laparoscopic colectomy reaching even better levels than before surgery. There was an early postoperative improvement in patients' emotional status. The main factors affecting HRQoL seem to be tumor stage, chemotherapy and male sex.
Colorectal Unit, 1st Department of Propaedeutic Surgery, Athens Medical School, 7 Semitelou Street, 11528, Athens, Greece. georgetheocrs@live.com
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Theodoropoulos
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Karantanos
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Stamopoulos
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Zografos
D000368:Aged; D001007:Anxiety / Q000209:etiology; D017024:Chemotherapy, Adjuvant / Q000523:psychology; D003082:Colectomy / Q000009:adverse effects / Q000523:psychology*; D003110:Colonic Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects; D003248:Constipation / Q000209:etiology; D004644:Emotions; D007172:Erectile Dysfunction / Q000209:etiology; D005260:Female; D006304:Health Status; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012004:Rectal Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D012737:Sex Factors; D058992:Social Participation; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors