Comparative Quality of Life in Patients Following Abdominoperineal Excision and Low Anterior Resection for Low Rectal Cancer
Comparative Quality of Life in Patients Following Abdominoperineal Excision and Low Anterior Resection for Low Rectal Cancer
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DOI：
10.1097/dcr.0b013e3182444fd1
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发表时间：
2012-04-01
影响因子：
3.9
通讯作者：
Moran, B.
中科院分区：
文献类型：
--
作者：
How, P.;Stelzner, S.;Moran, B.
背景：人们普遍认为，腹会阴切除术后的生活质量比低位前切除术后的生活质量更差。然而，这一观点并未得到明确支持。 目的：本研究的目的是比较低位直肠癌低位前切除术和腹会阴切除术患者 1 年后的生活质量。 设计：前瞻性收集 62 名接受低位前切除术 (32) 和腹会阴切除术 (30) 治疗肛缘 6 cm 以内低位直肠腺癌的患者的数据。患有转移性疾病的患者被排除在外。通过使用欧洲癌症研究与治疗组织的 QLQ-C30 和 QLQ-CR38 模块以及康乐保造口生活质量问卷来评估生活质量。通过使用圣马克肠道功能问卷来评估肠道功能。将接受低位前切除术的患者与接受腹会阴切除术的患者在术前和术后 1 年的生活质量进行比较。 地点：本研究在英国 3 个中心和欧洲 1 个中心进行。患者：包括肛缘 6 cm 以内的连续直肠癌患者，所有患者都提供了参与的书面同意书。 主要观察指标：Mann-Whitney U 检验比较接受低位前切除术和腹会阴切除术的患者的 QLQ-C30 和 QLQ-CR38 模块评分是测量的主要结果。 结果：接受低位前切除术的患者较年轻（中位年龄，59.5 vs 67，p = 0.03），肿瘤较高（4 vs 3，p < 0.001），接受新辅助治疗的可能性较小（p = 0.02）。术后 1 年，总体生活质量评级相当，但接受腹会阴切除术的患者报告有更好的认知功能（100 vs 83，p = 0.018）和社交功能（100 vs 67，p = 0.012），并且疼痛（0 vs 17，p = 0.027）、睡眠障碍（0 vs 33，p = 0.027）方面的症状较少。 0.013）、腹泻（0 vs 33，p = 0.017）和便秘（p = 0.021）。接受低位前切除术的患者报告性功能更好（33 vs 0，p = 0.006），但 72% 的患者出现一定程度的大便失禁。 局限性：本研究因其样本量相对较小而受到限制。结论：仅从生活质量来看，腹会阴切除术不应被视为在治疗低位直肠癌方面逊于低位前切除术的手术。
BACKGROUND: It is widely believed that quality of life is worse after abdominoperineal excision then after low anterior resection. However, this view is not supported unequivocally.OBJECTIVE: The aim of this study was to compare quality of life in patients 1 year following low anterior resection and abdominoperineal excision for low rectal cancer.DESIGN: Data were collected prospectively on 62 patients undergoing low anterior resection (32) and abdominoperineal excision (30) for low rectal adenocarcinoma within 6 cm of the anal verge. Patients with metastatic disease were excluded. Quality of life was assessed by the use of the European Organization for Research and Treatment of Cancer's QLQ-C30 and QLQ-CR38 modules and Coloplast stoma quality-of-life questionnaire. Bowel function was assessed by using the St Mark's bowel function questionnaire. Quality of life in patients who had low anterior resection was compared with those who had abdominoperineal excision both preoperatively and 1 year after surgery.SETTINGS: This study was conducted at 3 centers in the United Kingdom and 1 center in Europe.PATIENTS: Included were consecutive patients with rectal cancer within 6 cm of the anal verge, all of whom provided written consent for participation.MAIN OUTCOME MEASURES: Mann-Whitney U test comparisons of QLQ-C30 and QLQ-CR38 module scores for patients undergoing low anterior resection and abdominoperineal excision were the main outcomes measured.RESULTS: Patients undergoing low anterior resection were younger (median age, 59.5 vs 67, p = 0.03) with higher tumors (4 vs 3, p < 0.001) and less likely to receive neoadjuvant therapy (p = 0.02). At 1 year postoperatively, global quality-of-life ratings were comparable, but patients undergoing abdominoperineal excision reported better cognitive (100 vs 83, p = 0.018) and social (100 vs 67, p = 0.012) function, and less symptomatology with respect to pain (0 vs 17, p = 0.027), sleep disturbance (0 vs 33, p = 0.013), diarrhea (0 vs 33, p = 0.017), and constipation (p = 0.021). Patients undergoing low anterior resection reported better sexual function (33 vs 0, p = 0.006), but 72% experienced a degree of fecal incontinence.LIMITATIONS: This study was limited by its relatively small sample size.CONCLUSION: Abdominoperineal excision should not be regarded as an operation that is inferior to low anterior resection in the management of low rectal cancer on the basis of quality of life alone.