Predictors of fecal incontinence and related quality of life after a total mesorectal excision with primary anastomosis for patients with rectal cancer.
OBJECTIVE
After total mesorectal excision (TME) with primary anastomosis for patients with rectal cancer, the quality of life (QoL) may be decreased due to fecal incontinence. This study aimed to identify predictors of fecal incontinence and related QoL.


METHODS
Patients who underwent TME with primary anastomosis for rectal cancer between December 2008 and June 2012 completed the fecal incontinence quality of life scale (FIQoL) and Wexner incontinence score. Factors associated with these scores were identified using a linear regression analysis.


RESULTS
A total of 80 patients were included. Multivariate analysis identified a diverting ileostomy (n = 58) as an independent predictor of an unfavorable outcome on the FIQoL subscale coping/behavior (P = 0.041). Ileostomy closure within and after 3 months resulted in median Wexner scores of 5.0 (interquartile range [IQR], 2.5-8.0) and 10.5 (IQR, 6.0-13.8), respectively (P < 0.001). The median FIQoL score was 15.0 (IQR, 13.1-16.0) for stoma closure within 3 months versus 12.0 (IQR, 10.5-13.9) for closure after 3 months (P = 0.001).


CONCLUSIONS
A diverting ileostomy is a predictor for an impaired FIQoL after a TME for rectal cancer. Stoma reversal within 3 months showed better outcomes than reversal after 3 months. Patients with a diverting ileostomy should be informed about the impaired QoL, even after stoma closure.
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Marieke S
MS
Walma
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Verena N N
VN
Kornmann
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Djamila
D
Boerma
Department of Surgery, Rivierenland Hospital, Tiel, The Netherlands.
Marnix A J
MA
de Roos
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Henderik L
HL
van Westreenen
Fecal incontinence; Ileostomy; Quality of life; Rectal neoplasms