Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, New South Wales, Australia; RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, New South Wales, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Eur J Surg Oncol. 2024 Nov;50(11):108640. doi: 10.1016/j.ejso.2024.108640. Epub 2024 Aug 24.
Pelvic exenteration provides significant survival benefits for selected patients diagnosed with locally advanced rectal cancer. However, in-hospital postoperative morbidity such as abdominal abscess, sepsis, and anastomotic leak remain highly prevalent, which can have short/long-term impacts on patient quality of life (QoL). The aim of this study was to determine the influence of postoperative morbidity on QoL outcomes in patients following pelvic exenteration.
This prospective cohort study included patients who underwent pelvic exenteration at a tertiary teaching hospital in Sydney, between 2008 and 2023. QoL measures were collected at baseline, 6, 12, 18, 24, 36, 48, and 60 months using the short-form 36 (SF-36v2) survey. The predictors included variables relating to postoperative morbidity, including hospital and ICU length of stay (LOS), post-discharge mortality and the number of postoperative complications. Mixed-effects analyses were used to determine the influence of these postoperative outcomes on physical and mental QoL trajectories.
This study included 674 patients, with a median age of 61 years. Shorter hospital and ICU LOS, and fewer or no postoperative complications were associated with higher physical QoL scores across all time points. Conversely, postoperative morbidity did not exhibit a significant impact on mental QoL scores. Furthermore, there was a longitudinal improvement in mental QoL outcomes compared to baseline, independent of postoperative morbidity.
Postoperative morbidity significantly impacted physical QoL outcomes after pelvic exenteration, whereas mental QoL outcomes were not influenced. Interventions aimed at mitigating postoperative morbidity may hold the potential to enhance long-term QoL outcomes following pelvic exenteration.
盆腔廓清术为确诊局部晚期直肠癌的特定患者提供了显著的生存获益。然而，术后住院期间的发病率，如腹部脓肿、脓毒症和吻合口漏，仍然非常普遍，这可能对患者的生活质量（QoL）产生短期/长期影响。本研究旨在确定盆腔廓清术后术后发病率对患者 QoL 结局的影响。
本前瞻性队列研究纳入了 2008 年至 2023 年期间在悉尼一家三级教学医院接受盆腔廓清术的患者。使用简明 36 项健康调查量表（SF-36v2）在基线、6、12、18、24、36、48 和 60 个月时收集 QoL 测量值。预测变量包括与术后发病率相关的变量，包括住院和 ICU 住院时间（LOS）、出院后死亡率和术后并发症的数量。混合效应分析用于确定这些术后结局对身体和精神 QoL 轨迹的影响。
本研究纳入了 674 例患者，中位年龄为 61 岁。较短的住院和 ICU LOS 以及较少或没有术后并发症与所有时间点的身体 QoL 评分较高相关。相反，术后发病率对精神 QoL 评分没有显著影响。此外，与基线相比，精神 QoL 结局存在纵向改善，与术后发病率无关。
盆腔廓清术后，术后发病率对身体 QoL 结局有显著影响，而精神 QoL 结局不受影响。旨在减轻术后发病率的干预措施可能有潜力提高盆腔廓清术后的长期 QoL 结局。
