Bowel Dysfunction After Low Anterior Resection With Neoadjuvant Chemoradiotherapy or Chemotherapy Alone for Rectal Cancer: A Cross-Sectional Study from China
Bowel Dysfunction After Low Anterior Resection With Neoadjuvant Chemoradiotherapy or Chemotherapy Alone for Rectal Cancer: A Cross-Sectional Study from China
复制标题
直肠癌低位前切除联合新辅助放化疗或单纯化疗后肠道功能障碍：来自中国的横断面研究
DOI：
10.1097/dcr.0000000000000801
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发表时间：
2017-07-01
影响因子：
3.9
通讯作者：
Wang, Lei
中科院分区：
文献类型：
--
作者：
Qin, Qiyuan;Huang, Binjie;Wang, Lei
背景：新辅助治疗在局部进展期直肠癌的治疗中起着至关重要的作用，但在恢复性手术后会损害肠功能。最佳决策需要充分的功能结果信息。目的：本研究旨在评估术后肠功能，并确定严重功能障碍的预测因素。设计：这项研究包括横断面队列和对骨盆解剖特征的回顾评估。地点：该研究在中国的一家三级胃肠病医院进行。患者：包括2012-2014年间接受新辅助放化疗或化疗但未接受放射治疗的直肠癌患者，以及根治性低位前切除术。主要观察指标：使用确认的低位前切除术综合征评分评估肠功能。术前MRI测量直肠壁、闭孔内肌和提肛肌的厚度。结果：总共确定了151名符合条件的患者，142名患者(94.0%)在手术后平均19个月参与其中。71.1%(101/142)的患者出现肠功能障碍，其中44.4%(63/142)的患者出现严重功能障碍。紧急和聚集性症状被发现是主要的干扰。回归分析发现，术前长疗程放疗(p<；0.001)和下三分之一肿瘤(p=0.002)与严重的肠功能障碍独立相关。肿瘤位于下三分之一(OR=14.06p<；0.001)或直肠壁增厚(OR=11.09p<；0.001)的受照患者发生严重功能障碍的风险显著增加。局限性：这项研究是基于有限的患者队列和初次手术后的适度随访。结论：直肠癌低位前切除术后肠功能常恶化。严重的肠功能障碍与术前长疗程放疗和下三分之一肿瘤显著相关，而放疗后直肠壁增厚是一个强有力的预测指标。治疗决定和患者同意应在提高对肠道症状负担的认识的同时实施。请参阅http://links.lww.com/DCR/A317.上的视频摘要
BACKGROUND: Neoadjuvant therapy plays a vital role in the treatment of locally advanced rectal cancer but impairs bowel function after restorative surgery. Optimal decision making requires adequate information of functional outcomes. OBJECTIVE: This study aimed to assess postoperative bowel function and to identify predictors for severe dysfunction. DESIGN: The study included a cross-sectional cohort and retrospective assessments of pelvic anatomic features. SETTINGS: The study was conducted at a tertiary GI hospital in China. PATIENTS: Included patients underwent neoadjuvant chemoradiotherapy or chemotherapy without radiation and curative low anterior resection for rectal cancer between 2012 and 2014. MAIN OUTCOME MEASURES: Bowel function was assessed using the validated low anterior resection syndrome score. The thicknesses of the rectal wall, obturator internus, and levator ani were measured by preoperative MRI. RESULTS: A total of 151 eligible patients were identified, and 142 patients (94.0%) participated after a median of 19 months from surgery. Bowel dysfunction was observed in 71.1% (101/142) of patients, with 44.4% (63/142) reporting severe dysfunction. Symptoms of urgency and clustering were found to be major disturbances. Regression analysis identified preoperative long-course radiotherapy (p < 0.001) and a lower-third tumor (p = 0.002) independently associated with severe bowel dysfunction. Irradiated patients with a lower-third tumor (OR = 14.06; p < 0.001) or thickening of the rectal wall (OR = 11.09; p < 0.001) had a markedly increased risk of developing severe dysfunction. LIMITATIONS: The study was based on a limited cohort of patients and moderate follow-up after the primary surgery. CONCLUSIONS: Bowel function deteriorates frequently after low anterior resection for rectal cancer. Severe bowel dysfunction is significantly associated with preoperative long-course radiotherapy and a lower-third tumor, and the thickening of rectal wall after radiation is a strong predictor. Treatment decisions and patient consent should be implemented with raising awareness of bowel symptom burdens. See Video Abstract at http://links.lww.com/DCR/A317.