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Zentralbl Chir 2005; 130(5): 393-399
DOI: 10.1055/s-2005-836878
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© Georg Thieme Verlag Stuttgart · New York

Sexualität und Lebensqualität bei Patienten mit Rektumkarzinomen

Quality of Life and Sexuality after Surgery for Rectal Cancer - A Follow-up StudyC. Schmidt1 , B. Bestmann2 , H. Lindemann3 , T. Küchler2 , M. Löhnert4 , B. Kremer1
  • 1Klinik für Allgemeine Chirurgie und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • 2Referenzzentrum Lebensqualität in der Onkologie, Universitätsklinikum Schleswig Holstein, Campus Kiel
  • 3Städtisches Krankenhaus Kiel, Abteilung für Chirurgie, Kiel
  • 4Städtisches Klinikum Bielefeld Rosenhöhe, Bielefeld
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Publication Date:
11 October 2005 (online)

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Zusammenfassung

Studien zur Lebensqualität (LQ) bei Patienten mit Rektumkarzinom haben gezeigt, dass die Sexualfunktion nach Operation bei Frauen besser ist als bei Männern und stark vom Operationsverfahren abhängt. Die Mehrzahl der Studien konnte jedoch wegen kleiner Fallzahlen und fehlender Adjustierung von Störgrößen keine konsistenten Aussagen treffen. Ziel der vorliegenden Studie war es, Sexualfunktion und geschlechtsspezifische Unterschiede bei Patienten mit Rektumkarzinomen zu untersuchen. Eingeschlossen wurden 570 Patienten, die von Januar 1992 bis Januar 1999 operiert worden waren. Nach Feststellung des Überlebensstatus konnten 325 Patienten postalisch mit dem EORTC-QLQ-C-30 und einem tumorspezifischen Modul befragt werden. 245 Patienten waren tumorassoziiert verstorben, 51 (15,6 %) Patienten lehnten die Teilnahme ab, 215 Fragebogen konnten ausgewertet werden. Von den Patienten waren 103 weiblich, 112 männlich, das Durchschnittsalter lag bei 63,71 (± 10,1) Jahren, die durchschnittliche Überlebenszeit nach zwei Jahren bei 81,3 % und nach fünf Jahren bei 77,5 %. Die zu untersuchenden Kollektive waren vergleichbar. Patienten nach abdomino-perinealer Rektumresektion waren stärker in ihrer Sexualfunktion eingeschränkt als Patienten mit anderen OP-Verfahren. Männer werden durch die OP signifikant stärker in ihrer Sexualfunktion eingeschränkt als Frauen und fühlen sich dadurch stärkerem Stress ausgesetzt. Frauen fühlen sich hingegen durch die medizinische Behandlung insgesamt stärker belastet, was sich in höheren Skalenwerten für Fatigue und Schlaflosigkeit widerspiegelt. Es bestehen geschlechtsspezifische Unterschiede in der Wahrnehmung der postoperativen LQ bei Patienten mit Rektumkarzinom. Die Art des Operationsverfahrens beeinflusst die Sexualfunktion signifikant. Aufgrund des retrospektiven Designs muss die Studie jedoch prospektiv wiederholt werden, um verlässliche Aussagen zur postoperativen LQ machen zu können. Dies wird zur Zeit in einem Modellvorhaben in Kiel umgesetzt.

Abstract

Background: Previous studies have suggested that sexuality following surgery for rectal cancer is better in women than in men and differs with type of surgery in terms of impact on Quality of Life. However, the findings were inconsistent. The aim of the presented study was to address these issues. Methods: 570 patients that had undergone surgery for rectal cancer in our department from 1992 to 1999 were included. After determination of survival status questionnaires on Quality of Life were sent to 370 patients one to two years post surgery. We analysed data from 215 patients of which 103 were female and 112 male. 248 patients died during the time observed. Statistical analysis was done with descriptive methods, Kaplan-Meier analysis (log rank test), T-test and analysis of variance using SPSS 11.0 for Windows. Results: Significant differences were seen in symptom scales between men and women. Women scored higher for distress through medical treatment and had higher values for insomnia, fatigue and constipation. Both sexes had impaired sexual life but men had significantly higher values and felt more distressed by the impairment of sexuality than women. For patients receiving abdominoperineal resection sexuality was most impaired. Anterior resection with pouch had a detrimental effect on diarrhoea and treatment strain. Conclusion: The study showed that sexuality is influenced by gender and type of surgery and impacts Quality of Life after surgery for rectal cancer. Assessing quality of life with generic and specific instruments is helpful to determine differences between surgical procedures, age, gender, and adjuvant therapy where standard parameters such as survival have their limitations.

Schlüsselwörter

Lebensqualität - Rektumkarzinom - Sexualität - Geschlechtsunterschiede

Key words

rectal cancer - sexuality - gender - quality of life - outcome

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Priv.-Doz. Dr. med. Christian E. SchmidtMPH 

Klinik für Allgemeine Chirurgie und Thoraxchirurgie · Universitätsklinikum Schleswig-Holstein · Campus Kiel

Arnold-Heller-Str. 7

24105 Kiel

Phone: 49/4 31/5 97 73 00

Fax: 49/4 31/5 97 73 73

Email: christian.schmidt@uk-sh.de