gms | German Medical Science

Introduction Quality of Life as an outcome parameter is considered increasingly important in surgery for colorectal cancer. Usually, clinical factors, such as the presence of a stoma, are considered crucial for postoperative QoL. Most studies on this issue used generic questionnaires, thereby neglecting more complex issues of personality. Materials and Methods We studied 93 consecutive patients undergoing surgery of the left colon or rectum. The patients were investigated preoperatively and 3, 6 and 12 months post surgery as well as 3 months after stoma reversal. In addition to generic and disease-specific questionnaires (SF-36, GLQI), personality traits (NEO-FFI) and sense of coherence (Antonovsky) were investigated. Furthermore, a semi-standardised interview was conducted by a clinical psychologist at every follow-up meeting. Results Physical factors, as well as the Sense of Coherence and the personality traits Emotional lability and Extraversion were significantly correlated with emotional QoL at all times. The interview data showed a significant correlation between personality factors and emotional problems, body image, preoperative fear and overall QoL. In the multivariate analysis, physical QoL at t2 was predicted by 22% by personality and SoC. Another 17% were predicted by physical QoL at t1 (SF-36) and 20% were predicted by the presence of physical symptoms. Diagnosis and pre-treatment accounted for only 6% and the presence of a stoma for 2% of the postoperative physical QoL, respectively, which was not significant. The results for the disease specific QoL were similar with 32% prediction by personality and SoC, 14% by QoL at t1 and 16% prediction by the presence of symptoms. The emotional QoL (SF-36) was predicted by 49% by personality, 12% by diagnosis and pre-treatment and 15% by the presence of symptoms. Again, the presence of a stoma accounted with only 1% for postoperative emotional QoL, which was not significant. Conclusion In our study, personality factors and the sense of coherence had am much greater influence on the postoperative Quality of Life the physical factors like tumour stage, pre-treatment or the presence of a stoma. These factors have to be taken into account when QoL of life is the main outcome parameter e. g. when weighing ultralow sphincter-sparing rectal resections against abdominoperineal resections.