Ihn Myong Hoon, Kang Sung-Bum, Kim Duck-Woo, Oh Heung-Kwon, Lee Soo Young, Hong Sa Min
Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Dis Colon Rectum. 2014 Aug;57(8):958-66. doi: 10.1097/DCR.0000000000000163.
Until recently, no studies have prospectively evaluated bowel function after sphincter-preserving surgery for rectal cancer with the use of a validated bowel function scoring system.
The aim of this study was to investigate possible risk factors for altered bowel function after sphincter-preserving surgery.
This was a prospective study.
The study was conducted between January 2006 and May 2012 at the authors' institution.
Patients who underwent sphincter-preserving rectal cancer surgery were recruited.
Bowel function was assessed 1 day before (baseline) and at 1 year after sphincter-preserving surgery or temporary ileostomy takedown with the use of the Memorial Sloan Kettering Cancer Center questionnaire. Multivariable analysis was performed to identify the factors associated with altered bowel function after surgery.
Overall, 266 patients were eligible for the analysis. The tumor was located in the upper, middle, and lower rectum in 68 (25.5%), 113 (42.5%), and 85 (32.0%) patients. Intersphincteric resection and temporary ileostomy were performed in 18 (6.8%) and 129 (48.5%) patients. The mean Memorial Sloan Kettering Cancer Center score was 64.5 ± 7.6 at 1 year after sphincter-preserving surgery or temporary ileostomy takedown. The Memorial Sloan Kettering Cancer Center score decreased in 163/266 patients (61.3%) between baseline and 1 year after surgery. Tumor location (p = 0.01), operative method (p = 0.03), anastomotic type (p = 0.01), and temporary ileostomy (p = 0.01) were associated with altered bowel function after sphincter-preserving surgery in univariate analyses. In multivariable analysis, only tumor location was independently associated with impaired bowel function after sphincter-preserving rectal cancer surgery.
This study was limited by its nonrandomized design and the lack of measurement before preoperative chemoradiotherapy.
We suggest that preoperative counseling should be implemented to inform patients of the risk of bowel dysfunction, especially in patients with lower rectal cancer, although this study cannot exclude the effect of chemoradiotherapy owing to the limitation of study.
直到最近，尚无研究使用经过验证的肠功能评分系统对保肛直肠癌手术后的肠功能进行前瞻性评估。
本研究旨在调查保肛手术后肠功能改变的可能危险因素。
这是一项前瞻性研究。
该研究于2006年1月至2012年5月在作者所在机构进行。
招募接受保肛直肠癌手术的患者。
在保肛手术或临时回肠造口关闭术前1天（基线）和术后1年，使用纪念斯隆凯特琳癌症中心问卷评估肠功能。进行多变量分析以确定与术后肠功能改变相关的因素。
总体而言，266例患者符合分析条件。肿瘤位于直肠上、中、下段的患者分别为68例（25.5%）、113例（42.5%）和85例（32.0%）。18例（6.8%）患者进行了括约肌间切除术，129例（48.5%）患者进行了临时回肠造口术。保肛手术或临时回肠造口关闭术后1年，纪念斯隆凯特琳癌症中心评分的平均值为64.5±7.6。在基线和术后1年之间，266例患者中有163例（61.3%）的纪念斯隆凯特琳癌症中心评分下降。单变量分析显示，肿瘤位置（p = 0.01）、手术方式（p = 0.03）、吻合类型（p = 0.01）和临时回肠造口术（p = 0.01）与保肛手术后肠功能改变相关。多变量分析显示，保肛直肠癌手术后，只有肿瘤位置与肠功能受损独立相关。
本研究受非随机设计限制，且缺乏术前放化疗前的测量。
我们建议应进行术前咨询，告知患者肠功能障碍的风险，尤其是低位直肠癌患者，尽管由于研究局限性，本研究不能排除放化疗的影响。
