• Florian Herrle, Flavius Sandra-Petrescu, Christel Weiss, Stefan Post, Norbert Runkel, and Peter Kienle.
• 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.
• Dis. Colon Rectum. 2016 Apr 1; 59 (4): 281-90.

BackgroundAfter 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.ObjectiveThe 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.DesignThis was a longitudinal, observational, multicenter study.SettingsThe study was conducted at 17 German colorectal centers.PatientsPatients with rectal cancer who planned for elective curative surgery with creation of temporary diverting stoma were included.Main Outcome MeasuresThis 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.ResultsA 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).LimitationsThe study was limited by its missing quality-of-life data for sexual function.ConclusionsThe 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.

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