Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
Abertawe Bro Morgannwg University Health Board, UK.
Eur J Surg Oncol. 2022 Nov;48(11):2238-2249. doi: 10.1016/j.ejso.2022.08.001. Epub 2022 Aug 11.
Shared decision-making in pelvic exenteration is a complex and detailed process, which must balance clinical, oncological and patient-reported outcomes (PROs), whilst addressing and valuing the patient priorities. Communicating patient-centred information on quality of life (QoL) and functional outcomes is an essential component of this. The aim of this systematic review was to understand the impact of pelvic exenteration on QoL PROs over a longitudinal period and to develop QoL trajectories to support decision-making in this context.
MEDLINE, Embase and Web of Science databases were searched between 1 January 2000 and 20 December 2021 Studies reporting on PROs, including QoL, in adults undergoing pelvic exenteration were included. Risk of bias was assessed using the ROBINS-I assessment tool. Data from studies reporting QoL using the same outcome measure at the same candidate timepoint were extracted and synthesised to develop a longitudinal QoL trajectory.
Fourteen studies consisting of 1370 patients were included in this review. QoL trajectories were constructed in the domains of physical function, psychological function, role function, sexual function, body image and general and specific symptoms. Decision-making was only assessed by one study, with satisfaction with decision-making reported to be high. There is an initial decline in QoL scores in the domains of physical function, role function, sexual function, body image and general health and symptoms deteriorating during the first 3-6 months post-operatively. Psychological function is the only QoL domain that remains stable throughout the post-operative period.
Mapping QoL trajectories provides a visual representation of post-operative progress, highlighting the enduring impact of pelvic exenteration on patients and can be used to inform pre-operative shared decision-making.
盆腔廓清术的共同决策是一个复杂而详细的过程，必须平衡临床、肿瘤学和患者报告的结果（PROs），同时解决和重视患者的优先事项。传达关于生活质量（QoL）和功能结果的以患者为中心的信息是该过程的重要组成部分。本系统评价的目的是了解盆腔廓清术对 QoL PROs 的长期影响，并制定 QoL 轨迹，以支持该背景下的决策。
在 2000 年 1 月 1 日至 2021 年 12 月 20 日期间，检索了 MEDLINE、Embase 和 Web of Science 数据库。纳入了报告 PROs（包括 QoL）的成年人接受盆腔廓清术的研究。使用 ROBINS-I 评估工具评估偏倚风险。从报告使用相同结局测量指标且候选时间点相同的研究中提取 QoL 数据并进行综合，以制定纵向 QoL 轨迹。
本综述纳入了 14 项研究，共 1370 例患者。构建了生理功能、心理功能、角色功能、性功能、身体形象以及一般和特定症状等领域的 QoL 轨迹。只有一项研究评估了决策，报告的决策满意度很高。在生理功能、角色功能、性功能、身体形象和一般健康以及症状方面，QoL 评分最初下降，术后前 3-6 个月恶化。心理功能是唯一一个在整个术后期间保持稳定的 QoL 领域。
绘制 QoL 轨迹提供了术后进展的直观表示，突出了盆腔廓清术对患者的持久影响，可用于告知术前共同决策。
