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Intervention Review

Quality of life after rectal resection for cancer, with or without permanent colostomy.

  1. Jørn Pachler1,*,
  2. Peer Wille-Jørgensen2

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 20 APR 2005

Assessed as up-to-date: 22 FEB 2010

DOI: 10.1002/14651858.CD004323.pub3


How to Cite

Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy.. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004323. DOI: 10.1002/14651858.CD004323.pub3.

Author Information

  1. 1

    H/S Bispebjerg Hospital, Department of Surgical Gastroenterology K, Copenhagen NV, Denmark

  2. 2

    Bispebjerg Hospital, Department of Surgical Gastroenterology K, Copenhagen NV, Denmark

*Jørn Pachler, Department of Surgical Gastroenterology K, H/S Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen NV, DK 2400, Denmark. joern.pachler@hh.hosp.dk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

This is not the most recent version of the article. View current version (12 DEC 2012)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

For almost one hundred years abdominoperineal excision has been the standard treatment of choice for rectal cancer. With advances in the techniques for rectal resection and anastomosis, anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, except for those cancers very close to the anal sphincter. The main reason for this has been the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing an operation with a sphincter-preserving technique.
However, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from stoma-patients.

Objectives

To compare the quality of life in rectal cancer patients with or without permanent colostomy.

Search methods

We searched PUBMED, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Colorectal Cancer Group's specialised register. Abstract books from major gastroenterological and colorectal congresses were searched. Reference lists of the selected articles were scrutinized.

Selection criteria

All controlled clinical trials and observational studies in which quality of life was measured in patients with rectal cancer having either abdominoperineal excision/Hartmann's operation or low anterior resection, using a validated quality of life instrument, were considered.

Data collection and analysis

One reviewer (JP) checked the titles and abstracts identified from the databases and hand search. Full text copies of all studies of possible relevance were obtained. The reviewer decided which studies met the inclusion criteria.
Both reviewers independently extracted data. If information was insufficient the original author was contacted to obtain missing data. Extracted data were cross checked and discrepancies resolved by consensus.

Main results

Fifty-five potential studies were identified. Twenty-six of these, all non-randomised and representing 3675 participants met the inclusion criteria. Ten trials found that people undergoing abdominoperineal excision/Hartmann's operation did not have poorer quality of life measures than patients undergoing anterior resection. The rest of the studies found some difference, but not always in favour of non-stoma patients.
Due to clinical heterogeneity and the fact that all studies were observational trials, meta-analysis of the included studies was not possible.

Authors' conclusions

The studies included in this review do not allow firm conclusions as to the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/Hartmann's operation. The included studies challenges the assumption that anterior resection patients fare better.
Larger, better designed and executed prospective studies are needed to answer this question.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

No apparent differences in quality of life are found in rectal cancer patients with a permanent stoma when compared to non-stoma patients.

For patients diagnosed with rectal cancer, surgery is the definite treatment. The surgical outcome is either restored bowel continuity, or the formation of a stoma. Traditionally the formation of a colostomy has been regarded as an unfavourable outcome, as the quality of life of stoma patients is believed to be inferior compared to that in non-stoma patients. The included studies in this review do not support this assumption, although firm conclusions cannot be drawn.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

有或沒有進行永久性結腸造口術(permanent colostomy),患者在切除直腸癌後的生活品質變化

在過去將近一百年以來,腹部會陰切除手術(abdominoperineal excision)已經成為治療直腸癌的標準方法,因為這些技術對於直腸切除和吻合處具有好處,除了那些出現癌細胞部位太過靠近肛門擴約肌的患者之外,可以保護擴約肌功能的前位切除術已經成為直腸癌治療的理想選擇。腹部會陰切除術後進行結腸造口術的患者其生活品質,會比經歷括約肌保留手術的患者生活品質還要差,但是,接受擴約肌保護手術的患者可能會經歷與造口病患不同,因為症狀而造成的生活品質轉變

目標

本研究的主要目的在於比較直腸癌患者接受永久性結腸造口術和沒有接受永久性結腸造口術對生活品質的影響

搜尋策略

我們檢索了PUBMED、EMBASE、LILACS、Cochrane Central Register of Controlle Trials (CENTRAL)和Cochrane Colorectal Cancer Group's specialised register等資料庫中的相關試驗,主要的腸胃和大腸直腸研討會摘要手冊也會被檢索,被選取的試驗中的參考文獻也會被仔細察看

選擇標準

所有針對經歷腹部會陰切除或是低前位切除治療的直腸癌患者,利用驗證生活質量的工具來評估改變的對照性臨床試驗和觀察性試驗都會被納入研究中

資料收集與分析

有一個審閱者(JP)會確認由資料庫和手動檢索得到的試驗資料的標題和摘要,也取得可能具有相關性的試驗全文,另一名審閱者會決定哪些試驗符合納入研究的標準,2位審閱者會分別將資料萃取出來,。如果所得到的資訊有所缺漏,便會聯繫原始的試驗作者來取得遺漏的數據,取出的數據會經過交叉確認並且以協商的方式來解決差異性

主要結論

本研究中納入了46個可能相關的試驗,其中有20個以非隨機的方式進行並納入2682位受試者的試驗符合本研究的納入標準,有9個試驗發現接受腹腔會陰切除患者的生活品質並不會比接受前位切除患者的生活品質差,剩餘的試驗則有不同的發現,但是相關結果並不是一直偏向於非造口患者,因為臨床上的異質性和所有試驗都為觀察性試驗,並不可能將所有納入研究的試驗進行後設分析

作者結論

納入本研究的試驗並無法確認接受前位切除治療的患者其生活品質會優於接受腹部會陰切除的患者,被納入的試驗對於接受前位切除患者會具有較好生活品質的假設提出質疑,因此需要藉由更大規模並具有良好試驗設計的可行性前瞻性試驗來確認這些問題的答案

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

對於接受永久性造口治療和沒有經過造口治療的直腸癌患者來說,其生活品質的改變並沒有太大的差異。對於被診斷患有直腸癌的患者來說,接受手術是最明確的治療,手術的結果可能可以恢復腸道的連續性,或者是形成一個造口,傳統上結腸造口已經被視為一個不盡理想的手術成果,因為相對於沒有進行造口的患者來說,造口患者的生活品質被認為會受到影響,雖然並沒有獲得確切的結論,但是本研究所納入的試驗並不支持這上述的假設。