title: Quality of Life and Timing of Stoma Closure in Patients With Rectal Cancer Undergoing Low Anterior Resection With Diverting Stoma: A Multicenter Longitudinal Observational Study.
abstract: BACKGROUND
  After low anterior resection for rectal cancer, creation of a diverting stoma is recommended. Data on the impact of a diverting stoma on quality of life are conflicting. Optimal timing of stoma closure in the setting of adjuvant chemotherapy is unclear.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the impact of a diverting stoma on quality of life in patients undergoing rectal cancer resection before and after stoma closure. Furthermore, the study was conducted to look at the timing of stoma reversal and the potential influence of factors such as adjuvant chemotherapy.
  
  
  METHODS
  This was a longitudinal, observational, multicenter study.
  
  
  METHODS
  The study was conducted at 17 German colorectal centers.
  
  
  METHODS
  Patients with rectal cancer who planned for elective curative surgery with creation of temporary diverting stoma were included.
  
  
  METHODS
  This longitudinal observational study assessed quality of life at 3 occasions using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core Questionnaire/Colorectal Cancer Module before cancer resection, before stoma closure, and 6 months after stoma closure. Furthermore, the timing of stoma closure and continence were evaluated.
  
  
  RESULTS
  A total of 120 patients (64% men; mean age, 63.2 ± 11.5 years) were analyzed. Longitudinal global quality of life was not influenced by the presence of a stoma. Several functional and GI symptom scales were markedly impaired after stoma creation. Physical, role functioning, and sexual interest recovered after stoma closure. Social functioning stayed impaired (p < 0.0001). Median time to stoma closure was 5 months (range, 17 days to 18 months). A total of 3.4% of patients had very early stoma closure (within 30 days). Adjuvant chemotherapy delayed stoma closure (median, 5.6 vs 3.4 months without chemotherapy; p = 0.0001).
  
  
  CONCLUSIONS
  The study was limited by its missing quality-of-life data for sexual function.
  
  
  CONCLUSIONS
  The presence of a stoma had a negative impact on social functioning and GI symptoms. However, this had no clinically relevant influence on global quality of life. Time to stoma closure was nearly doubled when patients underwent adjuvant chemotherapy.
authors.affiliation: 1 Surgical Department, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany 2 Department for Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany 3 Schwarzwald-Baar Hospital, Department of General and Visceral Surgery, Villingen-Schwenningen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Herrle
authors.forename: Flavius
authors.initials: F
authors.lastname: Sandra-Petrescu
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Norbert
authors.initials: N
authors.lastname: Runkel
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D059186:Chemoradiotherapy, Adjuvant; D003125:Colostomy; D013505:Digestive System Surgical Procedures; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D007081:Ileostomy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012380:Role; D058992:Social Participation; D054047:Surgical Stomas; D011795:Surveys and Questionnaires; D013997:Time Factors