Center for Perioperative Optimization and Copenhagen Sequelae Center CARE, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark.
Curr Oncol. 2024 Oct 2;31(10):5929-5942. doi: 10.3390/curroncol31100442.
The frequency of long-term urination dysfunction after surgery for rectal cancer remains unclear, yet it is essential to establish this to improve treatment strategies. Randomized controlled trials (RCTs), non-RCTs, and cohort studies were included with patients having undergone sphincter-preserving total (TME) or partial mesorectal excision (PME) for the treatment of primary rectal cancer in this review. The outcome was urination dysfunction reported at least three months postoperatively, both overall urination dysfunction and subdivided into specific symptoms. The online databases PubMed, Embase, and Cochrane CENTRAL were searched, bias was assessed using the Newcastle-Ottawa scale, and results were synthesized using one-group frequency meta-analyses. A total of 55 studies with 15,072 adults were included. The median follow-up was 29 months (range 3-180). The pooled overall urination dysfunction was 21% (95% confidence interval (CI) 12%-30%) 3-11 months postoperatively and 25% (95% CI 19%-32%) ≥12 months postoperatively. Retention and incontinence were common 3-11 months postoperatively, with pooled frequencies of 11% and 14%, respectively. Increased urinary frequency, retention, and incontinence seemed even more common ≥12 months postoperatively, with pooled frequencies of 37%, 20%, and 23%, respectively. In conclusion, one in five patients experienced urination dysfunction more than a year following an operation for rectal cancer.
直肠癌手术后长期排尿功能障碍的频率尚不清楚，但确定这一点对于改善治疗策略至关重要。本综述纳入了经肛门直肠系膜全切除（TME）或部分直肠系膜切除术（PME）保肛治疗原发性直肠癌的患者的随机对照试验（RCT）、非随机对照试验和队列研究。结果为术后至少 3 个月报告的排尿功能障碍，包括总体排尿功能障碍和分为特定症状的排尿功能障碍。检索了在线数据库 PubMed、Embase 和 Cochrane CENTRAL，使用纽卡斯尔-渥太华量表评估偏倚，并使用单组频率荟萃分析综合结果。共纳入 55 项研究，涉及 15072 名成年人。中位随访时间为 29 个月（范围 3-180）。术后 3-11 个月总体排尿功能障碍的合并率为 21%（95%置信区间（CI）为 12%-30%），术后≥12 个月的合并率为 25%（95% CI 为 19%-32%）。术后 3-11 个月潴留和失禁很常见，合并频率分别为 11%和 14%。术后≥12 个月时，排尿频率增加、潴留和失禁似乎更为常见，合并频率分别为 37%、20%和 23%。总之，五分之一的直肠癌患者在手术后一年以上会出现排尿功能障碍。
