Functional Outcomes and Quality of Life after Redo Anastomosis in Patients With Rectal Cancer: An International Multicenter Comparative Cohort Study

Autor: A. Frontali, Yves Panis, Albert Wolthuis, Søren Laurberg, Pieter J. Tanis, Hossam Elfeki, Emma Westerduin, Therese Juul, André D'Hoore, Zaher Lakkis, Willem A. Bemelman
Přispěvatelé: Surgery, CCA - Imaging and biomarkers, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
Rok vydání: 2021
Předmět:
Male
Colorectal cancer
Anastomotic Leak
030230 surgery
Cohort Studies
0302 clinical medicine
Postoperative Complications
Quality of life
Belgium
Surveys and Questionnaires
Flatulence
Rectal cancer
Netherlands
Proctectomy
Anastomosis
Surgical
Gastroenterology
General Medicine
Functional outcome
Redo anastomosis
Middle Aged
Total mesorectal excision
Sindrome de
Anorectal Malformations
030220 oncology & carcinogenesis
Social function
Female
France
Cohort study
Reoperation
medicine.medical_specialty
Anastomosis
03 medical and health sciences
medicine
Humans
In patient
Aged
Neoplasm Staging
Retrospective Studies
Gynecology
business.industry
Rectal Neoplasms
medicine.disease
Functional Status
Low anterior resection syndrome
Quality of Life
Neoplasm Recurrence
Local
business
Redo surgery
Fecal Incontinence
Zdroj: Westerduin, E, Elfeki, H, Frontali, A, Lakkis, Z, Laurberg, S, Tanis, P J, Wolthuis, A M, Panis, Y, D'Hoore, A, Bemelman, W A & Juul, T 2021, ' Functional Outcomes and Quality of Life after Redo Anastomosis in Patients with Rectal Cancer : An International Multicenter Comparative Cohort Study ', Diseases of the Colon & Rectum, vol. 64, no. 7, pp. 822-832 . https://doi.org/10.1097/DCR.0000000000002025
Diseases of the colon and rectum, 822-832. Lippincott Williams and Wilkins
STARTPAGE=822;ENDPAGE=832;ISSN=0012-3706;TITLE=Diseases of the colon and rectum
ISSN: 1530-0358
0012-3706
Popis: BACKGROUND Redo anastomosis can be considered in selected patients with persistent leakage, stenosis, or local recurrence. It is technically challenging, and little is known about the functional outcomes after this seldomly performed type of surgery. OBJECTIVE The aim of this study was to compare functional outcomes and the quality of life between redo anastomosis and primary successful anastomosis following total mesorectal excision for rectal cancer. DESIGN This study was designed as an international multicenter comparative cohort study. SETTINGS The study was conducted in 3 tertiary referral centers in the Netherlands, Belgium, and France. PATIENTS Patients undergoing redo anastomosis were compared with patients with a primary successful anastomosis after total mesorectal excision for rectal cancer. MAIN OUTCOME MEASURES Low anterior resection syndrome score, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30, and EORTC QLQ-CR29 questionnaires were used to assess outcomes. RESULTS In total, 170 patients were included; 52 underwent redo anastomosis and 118 were controls. Major low anterior resection syndrome occurred in 73% after redo anastomosis compared with 68% following primary successful anastomosis (p = 0.52). The redo group had worse EORTC QLQ-CR29 mean scores for fecal incontinence (p = 0.03) and flatulence (p = 0.008). There were no differences in urinary (p = 0.48) or sexual dysfunction, either in men (p = 0.83) or in women (p = 0.76). Significantly worse scores in the redo group were found for global health (p = 0.002), role (p = 0.049) and social function (p = 0.006), body image (p = 0.03), and anxiety (p = 0.02). LIMITATIONS This study is limited by the possible response bias. CONCLUSIONS Redo anastomosis is associated with significantly worse quality of life compared with primary successful anastomosis. However, major low anterior resection syndrome was comparable between groups and should not be a reason to preclude restoration of bowel continuity in highly motivated patients. See Video Abstract at http://links.lww.com/DCR/B565. RESULTADOS FUNCIONALES Y DE CALIDAD DE VIDA POSTERIOR A LA RECONSTRUCCIN DE LA ANASTOMOSIS EN PACIENTES CON CNCER DE RECTO ESTUDIO INTERNACIONAL MULTICNTRICO DE COHORTE COMPARATIVO ANTECEDENTES:Se puede considerar reconstruir la anastomosis en pacientes seleccionados con fuga persistente, estenosis o recidiva local. Esto es tecnicamente desafiante y poco se sabe sobre los resultados funcionales despues de este tipo de cirugia que rara vez se realiza.OBJETIVO:El objetivo de este estudio fue comparar resultados funcionales y la calidad de vida entre reconstruccion de la anastomosis y la anastomosis primaria exitosa posterior de la escision total de mesorrecto (TME) por cancer de recto.DISENO:Este estudio fue disenado como un estudio internacional multicentrico de cohorte comparativo.ENTORNO CLINICO:El estudio se llevo a cabo en tres centros de referencia terciarios en Holanda, Belgica y Francia.PACIENTES:Los pacientes sometidos a reconstruccion de anastomosis fueron comparados con pacientes con anastomosis primaria exitosa despues de TME por cancer de recto.PRINCIPALES MEDIDAS DE VALORACION:Los cuestionarios; Escala de Sindrome de Reseccion Anterior Baja (LARS), EORTC QLQ-C30, y QLQ-CR29, fueron utilizados para evaluar los resultados.RESULTADOS:En total, se incluyeron 170 pacientes; 52 reconstruccion de anastomosis y 118 controles. LARS ocurrio en el 73% posterior a la reconstruccion de la anastomosis en comparacion con el 68% posterior a la anastomosis primaria exitosa (p = 0,52). El grupo de reconstruccion tuvo peores puntuaciones medias de EORTC QLQ-CR29 para incontinencia fecal (p = 0,03) y flatulencia (p = 0,008). No hubo diferencias en disfuncion urinaria (p = 0,48) o sexual, ni en hombres (p = 0,83) ni en mujeres (p = 0,76). Se encontraron puntuaciones significativamente peores en el grupo de reconstruccion para salud global (p = 0,002), desempeno (p = 0,049) y funcion social (p = 0,006), imagen corporal (p = 0,03) y ansiedad (p = 0,02).LIMITACIONES:La limitacion de este estudio es el posible sesgo de respuesta.CONCLUSIONES:La reconstruccion de la anastomosis se asocia con una calidad de vida significativamente peor en comparacion con los pacientes con anastomosis primaria exitosa. Sin embargo, LARS fue comparable entre los grupos y no deberia ser una razon para impedir la restauracion de la continuidad intestinal en pacientes muy motivados. Consulte Video Resumen en http://links.lww.com/DCR/B565.
Databáze: OpenAIRE
Externí odkaz: