Department of Clinical Psychology and Psychobiology. Faculty of Psychology. University of Barcelona, Spain.
Department of Medical Oncology, Hospital Universitario Central of Asturias, Oviedo, Spain.
Surg Oncol. 2019 Dec;31:26-32. doi: 10.1016/j.suronc.2019.08.009. Epub 2019 Aug 23.
The aim of this study was to investigate the impact of curative surgery for non-metastatic digestive tract cancers on quality of life (QoL), psychological status, and coping strategies.
A prospective, transversal, multicenter study was conducted in 404 patients: 361 with colorectal, 44 with gastroesophageal, and 35 with pancreaticobiliary cancer six months after surgery. Participants completed questionnaires evaluating QoL, including functioning (EORTC-QLC-C30), coping strategies (Mini-MAC), and psychological distress (BSI-18).
The effects of surgery had a strong impact on functional domains, global QoL, and symptoms, especially in pancreaticobiliary and gastroesophageal cancer. Patients with pancreaticobiliary and gastroesophageal cancer had lower functional scale scores than those with colorectal cancer. Fatigue, appetite loss, diarrhea, depression, and psychological distress were the most common symptoms after surgery. Subjects with pancreaticobiliary cancer reported more fatigue, pain, insomnia, depression, somatization and psychological distress, whereas individuals with gastroesophageal cancer exhibited more fatigue, nausea/vomiting, diarrhea, depression, psychological distress, and helplessness than those with colorectal cancer. Only participants with colorectal cancer displayed improved QoL six months post-surgery, albeit their psychological state had worsened.
Surgeons should discuss expectations regarding symptoms and QoL with patients prior to surgery to minimize physical and psychological impact.
本研究旨在探讨非转移性消化道癌症的根治性手术对生活质量（QoL）、心理状态和应对策略的影响。
对 404 例患者（361 例结直肠、44 例胃食管、35 例胰胆）进行前瞻性、横断面、多中心研究，术后 6 个月时患者完成评估 QoL 的问卷，包括功能（EORTC-QLC-C30）、应对策略（Mini-MAC）和心理困扰（BSI-18）。
手术的影响对功能领域、整体 QoL 和症状有强烈影响，特别是在胰胆和胃食管癌症中。胰胆和胃食管癌症患者的功能量表评分低于结直肠癌症患者。术后最常见的症状是疲劳、食欲下降、腹泻、抑郁和心理困扰。胰胆癌症患者报告更多的疲劳、疼痛、失眠、抑郁、躯体化和心理困扰，而胃食管癌症患者比结直肠癌症患者更易出现疲劳、恶心/呕吐、腹泻、抑郁、心理困扰和无助感。只有结直肠癌症患者在手术后 6 个月 QoL 得到改善，尽管他们的心理状态恶化。
外科医生应在手术前与患者讨论症状和 QoL 的预期，以最大程度地减少身体和心理影响。
