Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
Center for Surgery and Public Health, Boston, Massachusetts.
Dis Colon Rectum. 2019 Jan;62(1):27-32. doi: 10.1097/DCR.0000000000001186.
There are different approaches for the surgical management of rectal-sparing familial adenomatous polyposis with variable impacts on both quality of life and survival.
The aim of this study was to quantify the trade-offs between total proctocolectomy with IPAA versus total colectomy with ileorectal anastomosis using decision analysis.
We created a disease simulation Markov model to simulate the clinical events after IPAA and ileorectal anastomosis for rectal-sparing familial adenomatous polyposis in a cohort of individuals at the age 30 years. We used available literature to obtain different transition probabilities and health-states utilities. The output parameters were quality-adjusted life-years and life-years. Deterministic and probabilistic sensitivity analyses were performed.
A decision analysis using a Markov model was conducted at a single center.
Patients with rectal-sparing familial adenomatous polyposis at age 30 years were included. Rectal-sparing familial adenomatous polyposis is defined as the presence of 0 to 20 polyps that can be removed endoscopically.
Quality-adjusted life-years were measured.
Our model showed that the mean quality-adjusted life-years for IPAA was 25.12 and for ileorectal anastomosis was 27.12 in base-case analysis. Mean life-years for IPAA were 28.81 and 28.28 for ileorectal anastomosis. A 1-way sensitivity analysis was performed for all of the parameters in the model. None of the deterministic sensitivity analyses changed the model results across the range of plausible values. Probabilistic analysis identified that, in 86.9% of scenarios, ileorectal anastomosis had improved quality-adjusted life-years compared with IPAA.
The study was limited by characteristics inherent to modeling studies.
Ileorectal anastomosis was found to be preferable for patients with rectal-sparing familial adenomatous polyposis when quality of life is taken into consideration. This model was robust based on both deterministic and probabilistic sensitivity analyses. These data should be taken into consideration when counseling patients regarding a surgical approach in rectal-sparing familial adenomatous polyposis. See Video Abstract at http://links.lww.com/DCR/A715.
直肠保留型家族性腺瘤性息肉病的手术治疗方法有多种，对生活质量和生存率的影响也各不相同。
本研究旨在通过决策分析量化直肠保留型家族性腺瘤性息肉病行预防性回肠直肠切除术（IPAA）与全结肠切除术联合回肠直肠吻合术（ileorectal anastomosis）的利弊权衡。
我们创建了一个疾病模拟 Markov 模型，以模拟直肠保留型家族性腺瘤性息肉病患者在 30 岁时接受 IPAA 和 ileorectal anastomosis 后的临床事件。我们使用现有文献获得了不同的转移概率和健康状态效用值。输出参数为质量调整生命年（QALY）和生命年。进行了确定性和概率敏感性分析。
在单一中心进行决策分析，采用 Markov 模型。
纳入 30 岁时患有直肠保留型家族性腺瘤性息肉病的患者。直肠保留型家族性腺瘤性息肉病定义为内镜下可切除 0 至 20 个息肉。
测量 QALY。
在基准分析中，IPAA 的平均 QALY 为 25.12 年，ileorectal anastomosis 的平均 QALY 为 27.12 年。IPAA 的平均生命年为 28.81 年，ileorectal anastomosis 的平均生命年为 28.28 年。对模型中的所有参数进行了单因素敏感性分析。在所有可能的数值范围内，没有任何确定性敏感性分析改变了模型结果。概率分析确定，在 86.9%的情况下，与 IPAA 相比，ileorectal anastomosis 改善了 QALY。
该研究受到建模研究固有特征的限制。
当考虑生活质量时，ileorectal anastomosis 被认为是直肠保留型家族性腺瘤性息肉病患者的首选治疗方法。基于确定性和概率敏感性分析，该模型具有稳健性。在为直肠保留型家族性腺瘤性息肉病患者提供手术方法咨询时，应考虑这些数据。详见视频摘要，网址：http://links.lww.com/DCR/A715。
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