Quyn A J, Austin K K S, Young J M, Badgery-Parker T, Masya L M, Roberts R, Solomon M J
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, 2050, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, 2050, Australia.
Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, 2050, Australia; Cancer Epidemiology and Cancer Services Research, Sydney School of Public Health, Sydney, New South Wales, 2050, Australia.
Eur J Surg Oncol. 2016 Jun;42(6):823-8. doi: 10.1016/j.ejso.2016.02.016. Epub 2016 Feb 24.
Radical surgery with pelvic exenteration offers the only potential for cure in patients with locally advanced primary rectal cancer. This study describes the clinical and patient-reported quality of life outcomes over 12 months for patients having pelvic exenteration for locally advanced primary rectal cancer at a specialised centre for pelvic exenteration.
Clinical data of consecutive patients undergoing pelvic exenteration for locally advanced primary rectal cancer and patient-reported outcomes were collected at baseline, hospital discharge and at 1, 3, 6, 9 and 12 months. Patient-reported outcomes included cancer-specific quality of life (QoL) and physical and mental health status. Quality of life trajectories were modelled over the 12 months from the date of surgery using linear mixed models.
104 patients with locally advanced rectal cancer underwent pelvic exenteration at Royal Prince Alfred Hospital, Sydney, between December 1994 and October 2014. Complete soft tissue exenteration was performed in 38%. A clear margin was obtained in 86% with a 62% overall five-year survival. QoL outcome questionnaires were completed by 62% of patient cohort. The average FACT-C score returned to pre-surgery QoL by 2 months after surgery, and the average QoL continued to increase slowly over the 12 months.
Our results support an aggressive approach to advanced primary rectal cancer and lend weight to the oncological role of pelvic exenteration for this group of patients. Quality of life improves rapidly after pelvic exenteration for locally advanced primary rectal cancer and continues to improve over the first year.
根治性盆腔脏器切除术是局部晚期原发性直肠癌患者唯一可能治愈的方法。本研究描述了在一家专门的盆腔脏器切除中心，接受局部晚期原发性直肠癌盆腔脏器切除术的患者在12个月内的临床及患者报告的生活质量结果。
收集连续接受局部晚期原发性直肠癌盆腔脏器切除术患者的临床资料以及患者报告的基线、出院时、术后1、3、6、9和12个月的结果。患者报告的结果包括癌症特异性生活质量（QoL）以及身心健康状况。使用线性混合模型对自手术日期起12个月内的生活质量轨迹进行建模。
1994年12月至2014年10月期间，104例局部晚期直肠癌患者在悉尼皇家阿尔弗雷德王子医院接受了盆腔脏器切除术。38%的患者进行了完整的软组织切除。86%的患者切缘清晰，总体五年生存率为62%。62%的患者队列完成了生活质量结果问卷。术后2个月时，平均FACT-C评分恢复到术前生活质量水平，并且平均生活质量在12个月内持续缓慢上升。
我们的结果支持对晚期原发性直肠癌采取积极的治疗方法，并为盆腔脏器切除术对这组患者的肿瘤学作用提供了有力支持。对于局部晚期原发性直肠癌患者，盆腔脏器切除术后生活质量迅速改善，并在第一年持续提高。
