HeSRU, Royal Devon and Exeter Hospital, Exeter, UK.
Bristol Centre for Surgical Research, University of Bristol, Bristol, UK.
BJS Open. 2021 Nov 9;5(6). doi: 10.1093/bjsopen/zrab101.
Low rectal cancers could be treated using restorative (anterior resection, AR) or non-restorative procedures with an end/permanent stoma (Hartmann's, HE; or abdominoperineal excision, APE). Although the surgical choice is determined by tumour and patient factors, quality of life (QoL) will also influence the patient's future beyond cancer. This systematic review of the literature compared postoperative QoL between the restorative and non-restorative techniques using validated measurement tools.
The review was registered on PROSPERO (CRD42020131492). Embase and MEDLINE, along with grey literature and trials websites, were searched comprehensively for papers published since 2012. Inclusion criteria were original research in an adult population with rectal cancer that reported QoL using a validated tool, including the European Organization for Research and Treatment of Cancer QLQ-CR30, QLQ-CR29, and QLQ-CR38. Studies were included if they compared AR with APE (or HE), independent of study design. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Outcomes of interest were: QoL, pain, gastrointestinal (GI) symptoms (stool frequency, flatulence, diarrhoea and constipation), and body image.
Nineteen studies met the inclusion criteria with a total of 6453 patients; all papers were observational and just four included preoperative evaluations. There was no identifiable difference in global QoL and pain between the two surgical techniques. Reported results regarding GI symptoms and body image documented similar findings. The ROBINS-I tool highlighted a significant risk of bias across the studies.
Currently, it is not possible to draw a firm conclusion on postoperative QoL, pain, GI symptoms, and body image following restorative or non-restorative surgery. The included studies were generally of poor quality, lacked preoperative evaluations, and showed considerable bias in the data.
低位直肠癌可以通过有恢复功能（前切除术，AR）或无恢复功能（Hartmann 手术，HE；或腹会阴联合切除术，APE）的程序进行治疗。尽管手术选择取决于肿瘤和患者因素，但生活质量（QoL）也会影响患者癌症以外的未来。本系统评价文献比较了使用验证测量工具的恢复性和非恢复性技术之间的术后 QoL。
该综述在 PROSPERO（CRD42020131492）上进行了注册。全面检索了 Embase 和 MEDLINE 以及灰色文献和试验网站，以获取自 2012 年以来发表的论文。纳入标准为针对直肠癌的成人人群的原始研究，使用验证工具报告 QoL，包括欧洲癌症研究和治疗组织（EORTC） QLQ-CR30、QLQ-CR29 和 QLQ-CR38。如果研究比较了 AR 与 APE（或 HE），无论研究设计如何，都将包括在内。使用非随机干预研究的风险偏倚评估工具（ROBINS-I）评估偏倚风险。感兴趣的结果是：QoL、疼痛、胃肠道（GI）症状（粪便频率、腹胀、腹泻和便秘）和身体形象。
19 项研究符合纳入标准，共有 6453 名患者；所有论文均为观察性研究，只有 4 项研究包括术前评估。两种手术技术之间的总体 QoL 和疼痛没有可识别的差异。关于 GI 症状和身体形象的报告结果记录了类似的发现。ROBINS-I 工具突出显示了研究中存在的重大偏倚风险。
目前，对于恢复性或非恢复性手术后的 QoL、疼痛、GI 症状和身体形象，还不可能得出明确的结论。纳入的研究通常质量较差，缺乏术前评估，并且数据存在相当大的偏差。
