Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study
Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study
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DOI：
10.1097/dcr.0000000000000552
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发表时间：
2016-04-01
影响因子：
3.9
通讯作者：
Moran, Brendan J.
中科院分区：
文献类型：
--
作者：
Battersby, Nick J.;Juul, Therese;Moran, Brendan J.
背景：恢复性前切除术被认为是大多数直肠癌患者的最佳手术方式，通常在此之前进行放射治疗。手术和术前放疗都会损害肠道功能，从而对生活质量产生不利影响。目的：本研究旨在报告与肠道相关的生活质量损害相关的症状和关键预测因素。设计：本研究包括一个横断面队列。设置：这是一项来自12个英国中心的多中心研究。患者：2001年至2012年期间，共有578例直肠癌患者接受了根治性修复性前切除术（平均值，术后5.25年）。患者完成评估肠功能障碍的结局指标（低前切除综合征评分），失禁（Wexner评分）和生活质量（欧洲癌症研究和治疗组织生活质量量表-核心30），加上一个锚问题：“总的来说，肠道功能如何影响你的生活质量？结果：有效率为80%（462/578）。总体而言，85%（391/462）的患者报告了肠道相关生活质量损害，40%（187/462）的患者报告了严重损害。据报道，“无”与“严重”损害的总体生活质量差异很大（22分; p < 0.001），最严重的症状是腹泻（25分; p < 0.001）、失眠（24分; p < 0.001）和疲劳（20分; p < 0.001）。回归分析表明，在60%和45%的低位直肠癌患者术前放疗和未放疗的情况下，与47%和33%的中/高位直肠癌患者术前放疗和未放疗的情况相比，存在严重的损伤。局限性：放射治疗的进展和治疗后症状控制的改善，虽然目前疗效有限，但这意味着这种同意援助的内容应在5至10年内重新评估。在进行修复性前切除术之前，直肠癌患者应该被告知肠道相关的生活质量损害是常见的。关键的风险因素是新辅助治疗和低肿瘤高度。这项研究提供了生活质量和功能结局数据，沿着同意书，这将加强术前患者的讨论。
BACKGROUND:Restorative anterior resection is considered the optimal procedure for most patients with rectal cancer and is frequently preceded by radiotherapy. Both surgery and preoperative radiotherapy impair bowel function, which adversely affects quality of life.OBJECTIVE:This study aimed to report symptoms associated with and key predictors for bowel-related quality-of-life impairment.DESIGN:The study included a cross-sectional cohort.SETTINGS:This was a multicenter study from 12 United Kingdom centers.PATIENTS:A total of 578 patients with rectal cancer underwent curative restorative anterior resection between 2001 and 2012 (median, 5.25 years postsurgery).MAIN OUTCOME MEASURES:Patients completed outcome measures that assessed bowel dysfunction (low anterior resection syndrome score), incontinence (Wexner score), and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30), plus an anchor question: "Overall how does bowel function affect your quality of life?"RESULTS:The response rate was 80% (462/578). Overall, 85% (391/462) of patients reported bowel-related quality-of-life impairment, with 40% (187/462) reporting major impairment. A large difference in global quality of life (22 points; p < 0.001) was reported for "none" versus "major" impairment, with greatest symptom severity being diarrhea (25 points; p < 0.001), insomnia (24 points; p < 0.001), and fatigue (20 points; p < 0.001). Regression analysis identified major impairment in 60% and 45% of patients with low rectal cancer treated with and without preoperative radiotherapy compared with 47% and 33% of middle/upper rectal cancers with and without preoperative radiotherapy.LIMITATIONS:Advances in radiotherapy delivery and improvements in posttreatment symptom control, although currently of limited efficacy, imply that the content of this consent aid should be re-evaluated in 5 to 10 years.CONCLUSIONS:Before a restorative anterior resection, patients with rectal cancer should be informed that bowel-related quality-of-life impairment is common. The key risk factors are neoadjuvant therapy and a low tumor height. This study presents quality-of-life and functional outcome data, along with a consent aid, that will enhance this preoperative patient discussion.