Colorectal Unit, First Department of Propaedeutic Surgery, Athens Medical School, Athens, Greece.
Dis Colon Rectum. 2014 Feb;57(2):158-66. doi: 10.1097/DCR.0000000000000040.
Anastomotic leaks after colorectal resections for cancer are a leading cause of postoperative morbidity, mortality, and long hospital stay. Few data exist on the potentially deleterious effect of the anastomotic leaks after proctectomy for cancer on patient health-related quality of life.
The aim of this study was to explore the effect of clinically evident anastomotic leaks on health-related quality of life after rectal cancer excision.
This is a case-matched study.
This study was conducted in a Greek academic surgical department.
Included were 25 patients undergoing low anterior resection complicated by an anastomotic leak (Clavien classification II, n = 14, and III, n = 11) and 50 patients undergoing low anterior resection with an uncomplicated course.
Health-related quality-of-life data were prospectively collected at fixed assessment time points (baseline, 3, 6, and 12 months postoperatively) by the use of validated questionnaires (Medical Outcomes Study Short Form 36, Gastrointestinal Quality of Life Index, European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30, and European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-CR29).
"Leak" patients required a longer hospitalization. Although the numbers of initially constructed defunctioning loop ileostomies were not significantly different between cases and controls, "leak" patients were required to remain with a stoma significantly more often at all postoperative assessment time points. No differences were observed in the baseline scores between the 2 groups. Physical function of "leak" patients was significantly worse at all postoperative assessment time points. At 6 and 12 months, their emotional and social function and overall quality-of-life scores were significantly decreased in comparison with the patients with an uncomplicated course. "Leak" patients experienced significantly more "stoma-related problems" and "sore skin" around the stoma site.
Limited number of patients, restriction of follow-up to the end of the first year, and heterogeneity in terms of the presentation, severity, and management of anastomotic leaks were the limitations of this study.
Anastomotic leaks have an adverse effect on postoperative health-related quality of life.
结直肠切除术后吻合口漏是术后发病率、死亡率和住院时间延长的主要原因。关于吻合口漏对癌症行直肠切除术后患者健康相关生活质量的潜在有害影响的数据很少。
本研究旨在探讨临床明显吻合口漏对直肠癌切除术后健康相关生活质量的影响。
这是一项病例匹配研究。
本研究在希腊学术外科部门进行。
包括 25 例低位前切除术伴吻合口漏（Clavien 分类 II，n = 14，III，n = 11）和 50 例低位前切除术无并发症的患者。
前瞻性地在固定评估时间点（基线、术后 3、6 和 12 个月）使用验证后的问卷（医疗结局研究简表 36 项、胃肠道生活质量指数、欧洲癌症研究与治疗组织生活质量问卷-30 项和欧洲癌症研究与治疗组织生活质量问卷-CR29）收集健康相关生活质量数据。
“漏”患者需要更长的住院时间。尽管病例组和对照组之间最初构建的预防性回肠造口术数量没有显著差异，但“漏”患者在所有术后评估时间点都需要更长时间保留造口。两组之间的基线评分没有差异。“漏”患者在所有术后评估时间点的身体功能均明显较差。在 6 个月和 12 个月时，与无并发症的患者相比，他们的情绪和社会功能以及总体生活质量评分明显降低。“漏”患者经历了更多的“造口相关问题”和造口部位周围的“皮肤疼痛”。
本研究的局限性在于患者数量有限、随访仅限于第一年结束以及吻合口漏的表现、严重程度和管理方面的异质性。
吻合口漏对术后健康相关生活质量有不良影响。
