Wong Jolene S M, Ng Irene A T, Juan Wen Kai D, Ong Whee Sze, Yang Grace M, Finkelstein Eric A, Gandhi Mihir, Ong Chin-Ann J, Seo Chin Jin, Zhu Hong-Yuan, Chia Claramae S
From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore.
Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore.
Ann Surg Open. 2022 Sep 26;3(4):e206. doi: 10.1097/AS9.0000000000000206. eCollection 2022 Dec.
To evaluate the trajectories and sustainability of health-related quality of life (HRQoL) outcomes after palliative gastrointestinal (GI) surgery and perioperative factors associated with HRQoL improvement postsurgery.
Palliative patients face a wide range of physical, emotional, social, and functional challenges. In evaluating the efficacy of palliative surgical interventions, a major pitfall of traditional surgical outcome measures is that they fall short of measuring outcomes that are meaningful to patients during end-of-life. HRQoL tools may provide a more comprehensive assessment of the true value and impact of palliative surgery.
We prospectively recruit advanced cancer patients undergoing palliative GI surgery. The Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was administered before and at regular intervals after surgery. HRQoL improvement was defined as ≥4-points increment in FACT-G total score over baseline. Duration of sustained HRQoL improvement above this threshold and factors associated with varying extents of HRQoL change were evaluated.
Of the 65 patients, intestinal obstruction was the most common indication for surgery (70.8%). The mean baseline FACT-G total score was 70.7 (95% CI: 66.3-75.1). Forty-six (70.8%) patients experienced HRQoL improvement after surgery. This HRQoL improvement was sustained over a median duration of 3.5 months and was driven mainly by improvements in patients' physical and emotional well-being. Albumin was significantly associated with the extent of HRQoL improvements ( = 0.043).
A clinically significant and sustained improvement in HRQoL was observed after palliative GI surgery. Patients with higher preoperative albumin levels were more likely to experience HRQoL improvements.
评估姑息性胃肠道（GI）手术后健康相关生活质量（HRQoL）结果的轨迹和可持续性，以及与术后HRQoL改善相关的围手术期因素。
姑息治疗患者面临广泛的身体、情感、社会和功能挑战。在评估姑息性手术干预的疗效时，传统手术结果测量的一个主要缺陷是它们无法测量对临终患者有意义的结果。HRQoL工具可能会对姑息性手术的真正价值和影响提供更全面的评估。
我们前瞻性招募接受姑息性GI手术的晚期癌症患者。在手术前和术后定期发放癌症治疗功能评估通用问卷（FACT-G）。HRQoL改善定义为FACT-G总分比基线增加≥4分。评估持续高于该阈值的HRQoL改善持续时间以及与不同程度HRQoL变化相关的因素。
65例患者中，肠梗阻是最常见的手术指征（70.8%）。FACT-G总分的平均基线值为70.7（95%CI：66.3-75.1）。46例（70.8%）患者术后HRQoL得到改善。这种HRQoL改善持续的中位时间为3.5个月，主要由患者身体和情感幸福感的改善驱动。白蛋白与HRQoL改善程度显著相关（=0.043）。
姑息性GI手术后观察到HRQoL有临床显著且持续的改善。术前白蛋白水平较高的患者更有可能经历HRQoL改善。
