*Clinical Trials Research Unit and †Leeds Institute of Molecular Medicine, University of Leeds; ‡John Goligher Colorectal Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Ann Surg. 2014 May;259(5):916-23. doi: 10.1097/SLA.0000000000000407.
To investigate the effect that complications have on patients' long-term quality of life (QoL) after curative colorectal cancer surgery.
Colorectal cancer surgery is a high risk, with approximately 1 in 3 patients suffering a complication. The long-term consequences of postoperative complications are important but have poorly been documented.
The MRC-CLASICC trial (laparoscopic-assisted vs open surgery for colorectal cancer) included prospective evaluation of QoL using validated scoring questionnaires: EORTC QLQ-C30/CR38 and EQ5D. These were used to compare QoL at 3, 6, 18, and 36 months to baseline values for patients categorized into 2 groups: (i) those suffering any complication and (ii) those suffering any of 5 common complications (wound, chest, anastomotic leak, hemorrhage, and cardiac event).
A total of 614 of 794 CLASICC patients were suitable for inclusion. Complications occurred in 215 (35.0%) patients, including: wound complications (61, 9.9%), chest infection (50, 8.1%), anastomotic leak (27, 4.4%), hemorrhage (14, 2.3%), and cardiac event (26, 4.2%). Significant long-term differences in QoL between patients with and without complications were found for Physical and Social Function, Role Functioning, and Body Image on EORTC QLQ-C30/QLQ-CR38 analysis and Mobility, Self-care, and Pain/Discomfort on EQ5D analysis. No significant differences were seen for emotional/cognitive functioning, global QoL, financial difficulties, or future perspectives. Risk factors of age, gender, ASA (American Society of Anesthesiologists) grade, and stoma moderated the impact of complications in the short- to medium-term QoL, but had less influence on long-term QoL.
Postoperative complications have adverse effects on long-term QoL, particularly for Physical, Role and Social Functioning, and Body Image, as well as for Mobility, Self-care, and Pain/Discomfort. These findings should inform future preoperative counseling and health care planning.
探讨结直肠癌症根治术后并发症对患者长期生活质量（QoL）的影响。
结直肠癌症手术风险较高，约有 1/3 的患者会出现并发症。术后并发症的长期后果很重要，但记录情况较差。
MRC-CLASICC 试验（腹腔镜辅助与开放式结直肠癌症手术）前瞻性评估使用验证评分问卷的 QoL：EORTC QLQ-C30/CR38 和 EQ5D。这些问卷用于比较 3、6、18 和 36 个月时患者的 QoL 与基线值，患者分为 2 组：（i）发生任何并发症的患者，（ii）发生 5 种常见并发症（伤口、胸部、吻合口漏、出血和心脏事件）之一的患者。
共有 794 名 CLASICC 患者中的 614 名适合纳入研究。215 名（35.0%）患者发生了并发症，包括：伤口并发症（61 例，9.9%）、胸部感染（50 例，8.1%）、吻合口漏（27 例，4.4%）、出血（14 例，2.3%）和心脏事件（26 例，4.2%）。EORTC QLQ-C30/QLQ-CR38 分析显示，有并发症和无并发症患者在身体和社会功能、角色功能和身体形象方面存在显著的长期 QoL 差异，EQ5D 分析显示，移动性、自我护理和疼痛/不适方面也存在差异。在情绪/认知功能、总体 QoL、经济困难或未来展望方面未见显著差异。年龄、性别、ASA（美国麻醉医师协会）分级和造口术等风险因素在短期至中期 QoL 中调节了并发症的影响，但对长期 QoL 的影响较小。
术后并发症对长期 QoL 有不利影响，特别是对身体、角色和社会功能以及身体形象、移动性、自我护理和疼痛/不适有影响。这些发现应告知未来的术前咨询和医疗保健计划。
