Long-term Functional Outcome After Right-Sided Complete Mesocolic Excision Compared With Conventional Colon Cancer Surgery: A Population-Based Questionnaire Study
Long-term Functional Outcome After Right-Sided Complete Mesocolic Excision Compared With Conventional Colon Cancer Surgery: A Population-Based Questionnaire Study
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DOI：
10.1097/dcr.0000000000001154
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发表时间：
2018-09-01
影响因子：
3.9
通讯作者：
Emmertsen, Katrine J.
中科院分区：
文献类型：
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作者：
Bertelsen, Claus Anders;Larsen, Helene M.;Emmertsen, Katrine J.
背景技术背景：完全结肠系膜切除术可改善结肠癌的长期预后，但可能存在肠功能障碍的风险。目的：本研究旨在研究与传统结肠癌切除术相比，右侧完全结肠系膜切除术是否与长期肠功能障碍的风险增加和生活质量降低相关。设计：数据来自一项比较完整结肠系膜切除术和传统结肠癌切除术的人群研究以及一项关于功能结局的全国问卷调查。选择2008年6月至2014年12月在4所大学结直肠中心进行的I期至III期结肠腺癌的选择性右侧结肠切除术。患者：2015年11月有762例患者有资格接受问卷调查。主要观察指标：测量的主要结果是腹泻的风险（布里斯托粪便量表评分为6-7），每天排便4次或以上，以及肠道功能对生活质量的影响。次要结局是其他肠道症状、慢性疼痛和欧洲癌症研究和治疗组织QLQ-C30测量的生活质量。一百四十一（63.8%）和324（59.9%）接受完全结肠系膜切除术和传统切除术的患者在中位3.99（四分位距，2.11-5.32）和4.11（四分位距，3.01-5.53）年（p = 0.04）。完全结肠系膜切除与腹泻风险增加无关（校正OR，1.07; 95% CI，0.57-1.95; p = 0.84），每日排便4次或以上（校正OR，1.16; 95% CI，0.57-2.24; p = 0.68），或生活质量较低（校正OR，0.84; 95% CI，0.49-1.40; p = 0.50）。完全结肠系膜切除与夜间排便无显著相关性，但与慢性疼痛或其他次要outcome.LIMITATIONS：这项研究是有限的，与未知的基线症状的回顾性设计。应答患者较年轻，但无明显选择偏倚。腹泻的结果似乎有点敏感的信息bias.CONCLUSION：右侧完全结肠系膜切除术似乎既不与肠功能障碍，也不损害生活质量相比，传统的手术。参见http://links.lww.com/DCR/A665上的视频摘要。
BACKGROUND: Complete mesocolic excision improves the long-term outcome of colon cancer but might carry a risk of bowel dysfunction.OBJECTIVE: This study aimed to investigate whether right-sided complete mesocolic excision is associated with an increased risk of long-term bowel dysfunction and reduced quality of life compared with conventional colon cancer resections.DESIGN: Data were extracted from a population-based study comparing complete mesocolic excision and conventional colon cancer resections and from a national questionnaire survey regarding functional outcome.SETTINGS: Elective right-sided colon resections for stage I to III colon adenocarcinoma were performed at 4 university colorectal centers between June 2008 and December 2014.PATIENTS: Seven hundred sixty-two patients were eligible to receive the questionnaire in November 2015.MAIN OUTCOME MEASURES: The primary outcomes measured were the risk of diarrhea (Bristol stool scale score of 6-7), 4 or more bowel movements daily, and the impact of bowel function on quality of life. Secondary outcomes were other bowel symptoms, chronic pain, and quality of life measured by the European Organisation for Research and Treatment of Cancer QLQ-C30.RESULTS: One hundred forty-one (63.8%) and 324 (59.9%) patients undergoing complete mesocolic excision and conventional resections responded after a median of 3.99 (interquartile range, 2.11-5.32) and 4.11 (interquartile range, 3.01-5.53) years (p = 0.04). Complete mesocolic excision was not associated with increased risk of diarrhea (adjusted OR, 1.07; 95% CI, 0.57-1.95; p = 0.84), 4 or more bowel movements daily (adjusted OR, 1.16; 95% CI, 0.57-2.24; p = 0.68), or lower quality of life (adjusted OR, 0.84; 95% CI, 0.49-1.40; p = 0.50). Complete mesocolic excision was associated nonsignificantly with nocturnal bowel movements, but not associated with chronic pain or other secondary outcomes.LIMITATIONS: This study was limited by the retrospective design with unknown baseline symptoms. Responding patients were younger but without obvious selection bias. The outcome diarrhea seemed somehow sensitive to information bias.CONCLUSION: Right-sided complete mesocolic excision seems associated with neither bowel dysfunction nor impaired quality of life when compared with conventional surgery. See Video Abstract at http://links.lww.com/DCR/A665.