Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada.
Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
Tech Coloproctol. 2022 Jul;26(7):515-527. doi: 10.1007/s10151-022-02594-0. Epub 2022 Mar 3.
Symptoms of bowel dysfunction after sphincter-preserving rectal cancer surgery have an important impact on health-related quality of life (HRQOL), but that relationship is complex. A better understanding of this relationship allows for better informed shared decision-making about surgery. Our objective was to perform a systematic review to determine which HRQOL domains are most affected by postoperative bowel dysfunction.
A systematic review of the CINAHL, Cochrane Library, Embase, Medline, PsycInfo, PubMed, Web of Science, and Scopus databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies that evaluated bowel function after sphincter-preserving rectal cancer surgery and assessed HRQOL using a validated instrument. The quality of HRQOL analysis was assessed using an 11-item checklist. The main outcome was the impact bowel dysfunction had on global and domain specific quality-of-life indices. The impact was evaluated for clinical relevance using the Minimum Clinical Important Difference (MCID) for each specific HRQOL instrument.
Out of 952 unique citations, 103 studies were full-text reviews. Eighteen studies met the inclusion criteria (4 prospective cohorts and 9 cross-sectional studies). Of the 15 studies with long-term follow-up, the time to assessment after surgery ranged from 1.2 to 14.6 years. The low anterior resection syndrome score and European Organization for Research and Treatment core quality-of-life questionnaire (EORTC QLQ-C30) were the most commonly used instruments. Medium and large magnitudes in MCID were seen for global health, social functioning, emotional functioning, fatigue, diarrhea, and financial difficulties. Among included studies, the most consistently reported functional domains affected by bowel function were social functioning and emotional functioning.
Following sphincter-preserving rectal cancer surgery, poor bowel function mainly affects the social and emotional functional domains of HRQOL, which in turn impact global scores. This finding can help inform patients about expected changes in HRQOL after rectal cancer surgery and facilitate individualized treatment decisions.
保肛直肠癌手术后的肠道功能障碍症状对健康相关生活质量（HRQOL）有重要影响，但这种关系很复杂。更好地了解这种关系可以使患者更好地参与到关于手术的共同决策中。我们的目的是进行一项系统综述，以确定哪些 HRQOL 领域受术后肠道功能障碍的影响最大。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 CINAHL、Cochrane 图书馆、Embase、Medline、PsycInfo、PubMed、Web of Science 和 Scopus 数据库进行了系统检索。我们纳入了评估保肛直肠癌手术后肠道功能并使用验证工具评估 HRQOL 的研究。使用 11 项清单评估 HRQOL 分析的质量。主要结果是肠道功能障碍对整体和特定领域生活质量指数的影响。使用每个特定 HRQOL 工具的最小临床重要差异（MCID）评估临床相关性的影响。
在 952 篇独特的引文中有 103 篇是全文综述。18 项研究符合纳入标准（4 项前瞻性队列研究和 9 项横断面研究）。在 15 项具有长期随访的研究中，手术评估后的时间范围从 1.2 到 14.6 年不等。低位前切除术综合征评分和欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ-C30）是最常用的工具。在 MCID 中观察到中大和大的幅度为整体健康、社会功能、情绪功能、疲劳、腹泻和经济困难。在纳入的研究中，报告最多的受肠道功能影响的功能领域是社会功能和情绪功能。
保肛直肠癌手术后，肠道功能不良主要影响 HRQOL 的社会和情绪功能领域，进而影响整体评分。这一发现可以帮助患者了解直肠癌手术后 HRQOL 的预期变化，并促进个体化的治疗决策。
