Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus, Denmark.
Colorectal Surgery Unit, Department of Surgery, Mansoura University Hospital, Mansoura, Egypt.
Br J Surg. 2019 Jan;106(1):142-151. doi: 10.1002/bjs.10979. Epub 2018 Sep 13.
Several studies have explored functional outcomes after rectal cancer surgery, but bowel dysfunction after sigmoid resection for cancer has hardly been considered. The aim of this study was to identify the prevalence and pattern of bowel dysfunction after resection for sigmoid cancer, and the impact of bowel function on quality of life (QoL) by comparison with patients who had polypectomy for cancer.
This was a national cross-sectional study. Data were collected from the Danish Colorectal Cancer Group database, and a questionnaire regarding bowel function and European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL questionnaire was sent to all Danish colonic cancer survivors treated with sigmoid resection or polypectomy between 2001 and 2014.
A total of 3295 patients (3061 sigmoid resection, 234 polypectomy) responded to the questionnaire (response rate 63·8 per cent). Twelve bowel symptoms were more prevalent after sigmoid resection, including: excessive straining, fragmentation, bloating, nocturnal defaecation, bowel false alarm, liquid stool incontinence, incomplete evacuation and sense of outlet obstruction. QoL impairment owing to bowel symptoms was reported in 16·6 per cent of patients in the resection group and 10·1 per cent after polypectomy (P = 0·008). Obstructed defaecation symptoms (ODS) were encountered significantly more often after sigmoid resection than following polypectomy (17·9 versus 7·3 per cent; P < 0·001). In the resection group, patients with ODS had substantial impairment on most aspects of QoL assessed by the EORTC QLQ-C30.
Sigmoid resection for cancer is associated with an increased risk of long-term bowel dysfunction; obstructed defaecation is prevalent and associated with substantial impairment of QoL.
已有多项研究探讨直肠癌手术后的功能预后，但对因癌症行乙状结肠切除术的肠功能紊乱问题却鲜有涉及。本研究旨在明确乙状结肠癌术后肠功能紊乱的发生率和类型，并通过与因癌症而行息肉切除术的患者相比较，评估肠功能对生活质量（QoL）的影响。
这是一项全国性的横断面研究。研究数据来自丹麦结直肠癌协作组数据库，通过问卷调查所有 2001 至 2014 年间接受乙状结肠切除术或息肉切除术的丹麦结直肠癌幸存者，了解其肠功能和欧洲癌症研究与治疗组织（EORTC）QLQ-C30 生活质量问卷的相关情况。
共 3295 例患者（乙状结肠切除术 3061 例，息肉切除术 234 例）对问卷做出回应（应答率为 63.8%）。乙状结肠切除术后 12 种肠症状更为常见，包括：过度用力、便条样、腹胀、夜间排便、排便紧迫感、水样便失禁、排便不净感和出口梗阻感。切除术组中有 16.6%的患者报告因肠症状导致 QoL 受损，而息肉切除术组这一比例为 10.1%（P=0.008）。与息肉切除术相比，乙状结肠切除术更易出现排便梗阻症状（ODS）（17.9%比 7.3%；P<0.001）。在切除术组中，ODS 患者的 EORTC QLQ-C30 评估的大多数 QoL 方面均存在显著受损。
乙状结肠癌切除术与长期肠功能紊乱风险增加相关，其中梗阻性排便障碍更为常见，并会导致 QoL 严重受损。
