Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: https://twitter.com/sarobitaille.
Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: https://twitter.com/MichaelMaalouf.
Surgery. 2023 Oct;174(4):813-818. doi: 10.1016/j.surg.2023.06.033. Epub 2023 Jul 24.
The impact of bowel dysfunction versus colostomy on quality of life after rectal cancer surgery is poorly understood.
To evaluate the quality of life after rectal cancer surgery in patients with colostomy versus restorative proctectomy.
A mixed-methods study measuring quality of life using the Patient-Generated Index, patients were asked to list up to 5 areas of their life affected by their surgery. Areas were then weighted according to patients' preferences for improvement to generate a score from 0-100. The areas reported by patients were linked to the International Classification of Functioning for content analysis. Bowel dysfunction was measured using the low anterior resection syndrome score, and patients were then grouped according to (1) colostomy, (2) no/minor, or (3) major low anterior resection syndrome. Quality of life was compared between groups.
Overall, 121 patients were included (colostomy n = 39, restorative proctectomy n = 82). There were no differences in demographics, neoadjuvant radiotherapy, or time to follow-up between groups. In the restorative proctectomy group, 53% had no/minor, and 47% had major low anterior resection syndrome. Overall, patients with colostomy had significantly lower quality-of-life scores than those with restorative proctectomy. However, patients with major low anterior resection syndrome scored similarly to those with colostomy. On content analysis, patients with colostomies reported more problems with sexual function, body image, and sports. Patients with restorative proctectomy reported more problems with sleep, using transportation, and taking care of themselves.
Colostomy has a more detrimental impact on quality of life than restorative proctectomy. However, bowel dysfunction severity is important to consider. The patient experience between treatments differs.
直肠癌手术后，肠功能障碍与结肠造口术对生活质量的影响尚不清楚。
评估结肠造口术与直肠保肛手术后患者的生活质量。
采用患者生成指数（Patient-Generated Index）进行混合方法研究，测量生活质量，患者被要求列出最多 5 个受手术影响的生活领域。然后根据患者对改善的偏好对这些领域进行加权，生成 0-100 分的评分。患者报告的领域与国际功能、残疾和健康分类进行内容分析相关联。采用低位前切除综合征评分来衡量肠功能障碍，然后根据（1）结肠造口术，（2）无/轻度或（3）中重度低位前切除综合征对患者进行分组。比较各组之间的生活质量。
共纳入 121 例患者（结肠造口术组 n=39，直肠保肛术组 n=82）。组间在人口统计学、新辅助放疗和随访时间方面无差异。在直肠保肛术组中，53%的患者为无/轻度，47%的患者为中重度低位前切除综合征。总体而言，结肠造口术组患者的生活质量评分明显低于直肠保肛术组。然而，中重度低位前切除综合征患者的评分与结肠造口术组相似。在内容分析中，结肠造口术患者报告性功能、身体形象和运动方面存在更多问题，而直肠保肛术患者报告睡眠、使用交通工具和自理方面存在更多问题。
结肠造口术对生活质量的影响大于直肠保肛术。然而，肠功能障碍的严重程度是需要考虑的重要因素。两种治疗方法的患者体验不同。
