背景:盆腔切除术为部分诊断为局部晚期直肠癌的患者提供了显著的生存益处。然而,院内术后发病率,如腹部脓肿,脓毒症,吻合口漏仍然非常普遍,这可能会对患者的生活质量(QoL)产生短期/长期影响。这项研究的目的是确定术后发病率对盆腔切除术后患者QoL结果的影响。
方法:这项前瞻性队列研究纳入了在悉尼三级教学医院接受盆腔切除术的患者,2008年至2023年。QoL测量是在基线时收集的,6、12、18、24、36、48和60个月使用短表格36(SF-36v2)调查。预测因素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果对身体和心理QoL轨迹的影响。
结果:本研究包括674名患者,平均年龄为61岁。较短的医院和ICULOS,在所有时间点,较少或无术后并发症与较高的身体QoL评分相关.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,心理QoL结果有纵向改善,独立于术后发病率。
结论:术后发病率显著影响盆腔切除术后的身体QoL结果,而精神QoL结果不受影响。旨在减轻术后发病率的干预措施可能具有增强盆腔切除术后长期QoL结果的潜力。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.