Yuge Kotaro, Miwa Keisuke, Fujita Fumihiko, Murotani Kenta, Shigaki Takahiro, Yoshida Naohiro, Yoshida Takefumi, Koushi Kenichi, Fujiyoshi Kenji, Nagasu Sachiko, Akagi Yoshito
Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan.
Front Oncol. 2023 May 19;13:1197131. doi: 10.3389/fonc.2023.1197131. eCollection 2023.
Reports on the long-term quality of life (QOL) over 3 years after surgery in patients who have undergone surgery for rectal cancer are limited. Therefore, we aimed to evaluate the long-term QOL of patients who underwent high anterior resection (HAR), low anterior resection (LAR), internal sphincter resection (ISR), or abdominoperineal resection (APR) for rectal cancer.
A questionnaire regarding QOL was sent to 360 patients with rectal cancer who underwent curative resection by HAR, LAR, ISR, or APR between January 2005 and December 2015. QOL was assessed using the short-form 36 (SF-36) and modified fecal incontinence QOL (mFIQL) questionnaire. QOL between surgical procedures was analyzed using a multivariate model adjusted for age, sex, and postoperative time.
A total of 144 patients responded with a median follow-up period of 94 months (range 38-233 months). According to surgical procedure, HAR was performed in 26 patients, LAR in 80 patients, ISR in 32 patients, and APR in 6 patients. Patients who underwent HAR had significantly better mFIQL scores than those who underwent LAR and ISR (p=0.013 and p=0004, respectively) and significantly better role/social component summary scores on the SF-36 subscales (p=0.007). No difference was observed in the mFIQL scores between patients who underwent ISR and those who underwent APR (p=0.8423). In addition, postoperative anastomotic leakage sutures did not influence the mFIQL and SF-36 scores after surgery.
The QOL of patients who underwent anus-preserving surgery was best in the HAR group, with the QOL of other groups similar to the APR group. These results suggest that anus- preserving surgery is acceptable from a QOL standpoint. However, a colostomy may be a more satisfactory procedure in some patients.
关于直肠癌手术后3年以上长期生活质量（QOL）的报告有限。因此，我们旨在评估接受直肠癌高位前切除术（HAR）、低位前切除术（LAR）、内括约肌切除术（ISR）或腹会阴联合切除术（APR）患者的长期生活质量。
向2005年1月至2015年12月间接受HAR、LAR、ISR或APR根治性切除术的360例直肠癌患者发送了一份关于生活质量的问卷。使用简短健康调查问卷（SF-36）和改良的大便失禁生活质量问卷（mFIQL）对生活质量进行评估。采用多变量模型分析手术方式之间的生活质量，该模型对年龄、性别和术后时间进行了调整。
共有144例患者回复，中位随访期为94个月（范围38 - 233个月）。根据手术方式，26例患者接受了HAR，80例患者接受了LAR，32例患者接受了ISR，6例患者接受了APR。接受HAR的患者mFIQL评分显著高于接受LAR和ISR的患者（分别为p = 0.013和p = 0.004），并且在SF-36子量表上的角色/社会成分总结评分显著更高（p = 0.007）。接受ISR的患者和接受APR的患者之间mFIQL评分未观察到差异（p = 0.8423）。此外，术后吻合口漏缝合对术后mFIQL和SF-36评分没有影响。
保留肛门手术患者的生活质量在HAR组中最佳，其他组的生活质量与APR组相似。这些结果表明，从生活质量的角度来看，保留肛门手术是可以接受的。然而，在某些患者中，结肠造口术可能是更令人满意的手术方式。
