【评论】直肠癌术后低位前切除综合征症状的远期变化:一项随机对照试验的纵向随访研究  

[Comment]Long-term changes in low anterior resection syndrome in survivors of rectal cancer:longitudinal follow-up of a randomized controlled trial

作　　者：窦若虚 何思祺 Dou Ruoxu;He Siqi

机构地区：[1]中山大学附属第五医院胃肠外科,广东珠海519000

出　　处：《结直肠肛门外科》2024年第3期364-365,共2页Journal of Colorectal & Anal Surgery

摘　　要：背景在直肠癌术后患者中,肠道功能障碍(亦称低位前切除综合征)常见而且会明显影响患者的生活质量。虽然尚缺乏长期纵向随访研究资料,但是人们通常认为该综合征的症状仅可在术后2年内得到改善。目的阐述低位前切除综合征患者在术后3年以远的纵向变化,并探讨与之相关的因素。设计在参与多中心FOWARC随机对照试验中队列规模最大的单中心开展长期纵向随访。设定单中心为四级转诊中心。患者研究对象为确诊直肠癌并接受长程新辅助化疗或放化疗,随后进行保括约肌的直肠切除术的患者。主要观察指标低位前切除综合征评分和造口状态的变化。结果在初始阶段——中位随访时间达39个月的随访中,有220例患者应答,其中178例(80.9%)在第二阶段——中位随访时间达83个月时应答。在此期间,低位前切除综合征评分的平均值从29.5(95%CI:28.3~30.7)降至18.6(95%CI:16.6~20.6)。56例(31.5%)患者的低位前切除综合征严重程度从“重度”变为“无/轻度”,6例(3.4%)患者由于严重的肠道功能障碍而新建造口。新辅助放疗(P=0.016)与低位前切除综合征评分降低呈独立负相关。局限性长期随访期间有患者失访。结论大多数罹患低位前切除综合征的直肠癌患者在直肠切除术后3年以远仍可获得症状的持续改善。新辅助放疗与低位前切除综合征症状的远期改善呈负相关。Background Postoperative bowel dysfunction,also known as low anterior resection syndrome,is common in rectal cancer survivors and significantly impacts quality of life.Although long-term longitudinal follow-up is lacking,improvement of the syndrome is commonly believed to happen only within the first 2 years.Objective This study aimed to depict the longitudinal evolvement of low anterior resection syndrome beyond 3 years and explore factors associated with changes.Design Longitudinal long-term follow-ups were performed for the single center with the largest cohort within the multicenter FOWARC randomized controlled trial.Setting A quaternary referral center.Patients Individuals diagnosed with rectal cancer who received long-course neoadjuvant chemotherapy or chemoradiotherapy,followed by sphincter-preserving radical proctectomy.Main outcome measurements Change of low anterior resection syndrome score and stoma status.Results Of the 220 patients responding to the first follow-up at a median of 39 months,178(80.9%)responded to the second follow-up after a median of 83 months.During this interval,the mean low anterior resection syndrome score improved from 29.5(95%CI,28.3-30.7)to 18.6(95%CI,16.6-20.6).Fifty-six(31.5%)patients reported improvement from major to no/minor severity,and 6(3.4%)patients had new stomas because of severe bowel dysfunction.Neoadjuvant radiotherapy(P=0.016)was independently and negatively associated with improvement of the score.Limitations Loss of follow-up during the long-term follow-ups.Conclusions Most rectal cancer survivors with low anterior resection syndrome continued to improve beyond 3 years after proctectomy.Neoadjuvant radiotherapy was negatively associated with long-term improvement of low anterior resection syndrome.

关 键 词：低位前切除综合征 纵向随访 新辅助放疗 直肠癌 

分 类 号：R574.4[医药卫生—消化系统]