目的:本研究的目的是评估直肠癌低位前切除术(LAR)后早期造口关闭对肠功能的影响。
方法:参与FORCE试验并接受LAR伴保护性造口的患者纳入本研究。患者被细分为早期封闭组(<3个月)和晚期封闭组(>3个月)。这项研究的终点是Wexner失禁,低位前切除综合征(LARS),EORTCQLQ-CR29和1年时大便失禁生活质量(FIQL)评分。
结果:在2017年至2020年之间,38例患者在LAR治疗直肠癌后接受了造口,可以纳入。LARS(31vs.30,p=0.63)和Wexner得分(6.2对5.8,p=0.77)在早期和晚期封闭组之间。恢复连续性后,造口闭合时间(天)不是LARS(R2=0.001,F(1,36)=0.049,p=0.83)或Wexner评分(R2=0.008,F(1,36)=0.287,p=0.60)的预测指标。生活方式的任何FIQL领域之间都没有显着差异,应对,抑郁症,和尴尬。在EORTCQLQ-29中,晚期闭合组的身体图像得分更高(21.3vs.1.6,p=0.004)。
结论:造口闭合时间似乎不会影响长期肠功能和生活质量,除了身体形象。为了改善功能结果,应该把注意力集中在其他因素上。
OBJECTIVE: The aim of this study was to assess the effect of early stoma closure on bowel function after low anterior resection (LAR) for rectal cancer.
METHODS: Patients participating in the FORCE trial who underwent LAR with protective stoma were included in this study. Patients were subdivided into an early closure group (< 3 months) and late closure group (> 3 months). Endpoints of this study were the Wexner Incontinence, low anterior resection syndrome (LARS), EORTC QLQ-CR29, and fecal incontinence quality of life (FIQL) scores at 1 year.
RESULTS: Between 2017 and 2020, 38 patients had received a diverting stoma after LAR for rectal cancer and could be included. There was no significant difference in LARS (31 vs. 30, p = 0.63) and Wexner score (6.2 vs. 5.8, p = 0.77) between the early and late closure groups. Time to stoma closure in days was not a predictor for LARS (R2 = 0.001, F (1,36) = 0.049, p = 0.83) or Wexner score (R2 = 0.008, F (1,36) = 0.287, p = 0.60) after restored continuity. There was no significant difference between any of the FIQL domains of lifestyle, coping, depression, and embarrassment. In the EORTC QLQ-29, body image scored higher in the late closure group (21.3 vs. 1.6, p = 0.004).
CONCLUSIONS: Timing of stoma closure does not appear to affect long-term bowel function and quality of life, except for body image. To improve functional outcome, attention should be focused on other contributing factors.