Wel of geen stoma: voorkeur en waardering

Abstract

Background: Patients with rectal cancer are often treated with either abdominoperineal resection (APR, i.e. with a permanent stoma) or low anterior resection (LAR, i.e. without a permanent stoma). The aim of this study was to compare surgery preferences and evaluations of surgery outcome states of patients treated for rectal cancer and of subjects without rectal cancer. The degree of preferred patient participation in the surgery decision was also examined. Methods: Surgery preferences and surgery outcome evaluations of 122 patients treated for rectal cancer with APR or LAR have been obtained from a previous study and compared to those obtained in a group of 27 participants without rectal cancer. Surgery preference and surgery outcome evaluations were assessed with the Treatment Trade-off method (TTM) and Time Trade-off method (TTO), respectively. The Control Preferences Scale (CPS) was used to assess the degree of preferred patient participation in the surgery decision. Results: Surgery preference differed between the three groups in both monthly and daily incontinence scenario (p < .001). Patients who had undergone APR highly preferred APR and those who had undergone LAR highly preferred LAR, whereas subjects without rectal cancer were in between. The evaluation of a permanent stoma was higher for patients who had undergone APR than for those who had undergone LAR and those who did not have rectal cancer (both p < .001), whereas the latter two groups did not differ from each other (p = .14). The evaluation of both monthly and daily incontinence did not differ between the three groups (p = .24 and p = .77, respectively). Almost all patients preferred to make the surgery choice together with their physician. This preference did not influence the surgery preference by itself (p = .36 - .38) nor the evaluations of the possible surgery outcome states (p = .11 - .48). Conclusions: The preference for a surgery without a permanent stoma (LAR) of subjects without rectal cancer are not as low as that of patients who had undergone APR and not as high as patients who had undergone LAR. Nevertheless, their evaluation of a permanent stoma was equal to that of patients who had undergone LAR and much lower than those who had undergone APR. In clinical practice we recommend to obtain the preferences for both the degree of participation in the surgery decision and for the type of surgery itself for a patient to prevent an unwanted decision.