Anterior Resection Syndrome and Quality of Life With Long-term Follow-up After Rectal Cancer Resection
Anterior Resection Syndrome and Quality of Life With Long-term Follow-up After Rectal Cancer Resection
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DOI：
10.1097/dcr.0000000000002107
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发表时间：
2022-10-01
影响因子：
3.9
通讯作者：
Stearns, Adam T.
中科院分区：
文献类型：
--
作者：
Dilke, Stella M.;Hadjittofi, Christopher;Stearns, Adam T.
背景：手术和系统治疗不断发展，使远端直肠癌的恢复性切除成为可能。这些手术与低位前切除综合征有关。最近的研究方法和尺寸的限制，调查了前切除术后低前切除综合征的发病率。然而，低位前切除综合征的长期发展轨迹及其对健康相关生活质量的影响尚不清楚。目的：本研究的目的是评估前切除术和回肠造口术逆转对长期健康相关生活质量和低位前切除综合征的影响。设计：分析患者的人口统计学资料以及低位前切除综合征和健康相关的生活质量定性评分背景：2003年至2016年期间，在英国2个高容量中心接受直肠前切除术治疗癌症伴功能障碍性回肠造口术的患者，排除发生吻合口瘘的患者。患者：在478例合格患者中，311例（65.1%）在前切除术后平均6.5 +/- 0.2年参与研究。参与者和非参与者的人口统计学资料和新辅助放化疗率相似（p > 0.05）。结果：发生主要低位前切除综合征的患者百分比为53.4%（166/311）。健康相关的生活质量功能领域评分在回肠造口术逆转后的几年中得到改善，便秘发生了显著变化（p = 0.01），社会功能（p = 0.03），情绪评分（p = 0.02），以及降低主要低位前切除综合征的患病率（p = 0.003）。局限性：本研究的主要局限性是收集的数据是横断面的而不是纵向的，并且无应答者可能有更严重的癌症症状。在这第一项评估前切除术和回肠造口逆转后长期功能的大规模研究中，主要低位前切除术综合征在6年后有线性改善，以及关键生活质量指标的改善。
BACKGROUND: Surgical and systemic therapies continue to advance, enabling restorative resections for distal rectal cancer. These operations are associated with low anterior resection syndrome. Recent studies with methodological and size limitations have investigated the incidence of low anterior resection syndrome after anterior resection. However, the long-term trajectory of low anterior resection syndrome and its effect on health-related quality of life remain unclear.OBJECTIVE: The purpose of this study was to assess the impact of anterior resection and reversal of ileostomy on long-term health-related quality of life and low anterior resection syndrome.DESIGN: Patient demographics were analyzed alongside low anterior resection syndrome and health-related quality-of-life qualitative scores (EORTC-QLQ-C30) obtained through cross-sectional postal questionnaires.SETTING: Patients who underwent anterior resection of the rectum for cancer with defunctioning ileostomy between 2003 and 2016 at 2 high-volume centers in the United Kingdom were identified, excluding those experiencing anastomotic leakage.PATIENTS: Among 478 eligible patients, 311 (65.1%) participated at a mean of 6.5 +/- 0.2 years after anterior resection. Demographics and neoadjuvant chemoradiotherapy rates were similar (p > 0.05) between participants and nonparticipants.RESULTS: The percentage of patients who experienced major low anterior resection syndrome was 53.4% (166/311). Health-related quality-of-life functional domain scores improved in the years after reversal of ileostomy, with significant changes in constipation (p = 0.01), social function (p = 0.03), and emotional scores (p = 0.02), as well as a reduction in the prevalence of major low anterior resection syndrome (p = 0.003).LIMITATIONS: The main limitation of this study was that the data collected were cross-sectional rather than longitudinal, and that nonresponders may have had worse cancer symptoms.CONCLUSIONS: In this first large-scale study assessing long-term function after anterior resection and reversal of ileostomy, there is a linear improvement in major low anterior resection syndrome beyond 6 years, alongside improvements in key quality-of-life measures.