Long-term Functional Outcome After Right-Sided Complete Mesocolic Excision Compared With Conventional Colon Cancer Surgery: A Population-Based Questionnaire Study

被引:28
作者
Bertelsen, Claus Anders [1 ]
Larsen, Helene M. [2 ]
Neuenschwander, Anders U. [1 ]
Laurberg, Soren [2 ]
Kristensen, Bent [3 ]
Emmertsen, Katrine J. [2 ,4 ]
机构
[1] Univ Copenhagen, North Zealand Hosp Hillerod, Dept Surg, Hillerod, Denmark
[2] Univ Aarhus, Aarhus Univ Hosp, Dept Surg, Aarhus, Denmark
[3] Univ Copenhagen, Herlev Univ Hosp, Dept Clin Physiol, Herlev, Denmark
[4] Univ Aarhus, Reg Hosp Randers, Dept Surg, Randers, Denmark
关键词
Complete mesocolic excision; Diarrhea; Long-term bowel function; Pain; Quality of life; Right-sided colon cancer; LOW ANTERIOR RESECTION; QUALITY-OF-LIFE; RECTAL-CANCER; IMPROVED SURVIVAL; MESORECTAL EXCISION; BOWEL DYSFUNCTION; DENMARK; IMPACT;
D O I
10.1097/DCR.0000000000001154
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND: Complete mesocolic excision improves the long-term outcome of colon cancer but might carry a risk of bowel dysfunction. OBJECTIVE: This study aimed to investigate whether right-sided complete mesocolic excision is associated with an increased risk of long-term bowel dysfunction and reduced quality of life compared with conventional colon cancer resections. DESIGN: Data were extracted from a population-based study comparing complete mesocolic excision and conventional colon cancer resections and from a national questionnaire survey regarding functional outcome. SETTINGS: Elective right-sided colon resections for stage I to III colon adenocarcinoma were performed at 4 university colorectal centers between June 2008 and December 2014. PATIENTS: Seven hundred sixty-two patients were eligible to receive the questionnaire in November 2015. MAIN OUTCOME MEASURES: The primary outcomes measured were the risk of diarrhea (Bristol stool scale score of 6-7), 4 or more bowel movements daily, and the impact of bowel function on quality of life. Secondary outcomes were other bowel symptoms, chronic pain, and quality of life measured by the European Organisation for Research and Treatment of Cancer QLQ-C30. RESULTS: One hundred forty-one (63.8%) and 324 (59.9%) patients undergoing complete mesocolic excision and conventional resections responded after a median of 3.99 (interquartile range, 2.11-5.32) and 4.11 (interquartile range, 3.01-5.53) years (p = 0.04). Complete mesocolic excision was not associated with increased risk of diarrhea (adjusted OR, 1.07; 95% CI, 0.57-1.95; p = 0.84), 4 or more bowel movements daily (adjusted OR, 1.16; 95% CI, 0.57-2.24; p = 0.68), or lower quality of life (adjusted OR, 0.84; 95% CI, 0.49-1.40; p = 0.50). Complete mesocolic excision was associated nonsignificantly with nocturnal bowel movements, but not associated with chronic pain or other secondary outcomes. LIMITATIONS: This study was limited by the retrospective design with unknown baseline symptoms. Responding patients were younger but without obvious selection bias. The outcome diarrhea seemed somehow sensitive to information bias. CONCLUSION: Right-sided complete mesocolic excision seems associated with neither bowel dysfunction nor impaired quality of life when compared with conventional surgery. See Video Abstract at http://links.lww.com/DCR/A665.
引用
收藏
页码:1063 / 1072
页数:10
相关论文
共 29 条
[1]   THE EUROPEAN-ORGANIZATION-FOR-RESEARCH-AND-TREATMENT-OF-CANCER QLQ-C30 - A QUALITY-OF-LIFE INSTRUMENT FOR USE IN INTERNATIONAL CLINICAL-TRIALS IN ONCOLOGY [J].
AARONSON, NK ;
AHMEDZAI, S ;
BERGMAN, B ;
BULLINGER, M ;
CULL, A ;
DUEZ, NJ ;
FILIBERTI, A ;
FLECHTNER, H ;
FLEISHMAN, SB ;
DEHAES, JCJM ;
KAASA, S ;
KLEE, M ;
OSOBA, D ;
RAZAVI, D ;
ROFE, PB ;
SCHRAUB, S ;
SNEEUW, K ;
SULLIVAN, M ;
TAKEDA, F .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1993, 85 (05) :365-376
[2]   Short-term outcomes after complete mesocolic excision compared with "conventional' colonic cancer surgery [J].
Bertelsen, C. A. ;
Neuenschwander, A. U. ;
Jansen, J. E. ;
Kirkegaard-Klitbo, A. ;
Tenma, J. R. ;
Wilhelmsen, M. ;
Rasmussen, L. A. ;
Jepsen, L. V. ;
Kristensen, B. ;
Goegenur, I. .
BRITISH JOURNAL OF SURGERY, 2016, 103 (05) :581-589
[3]  
Bertelsen CA, 2017, DAN MED J, V64
[4]   Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study [J].
Bertelsen, Claus Anders ;
Neuenschwander, Anders Ulrich ;
Jansen, Jens Erik ;
Wilhelmsen, Michael ;
Kirkegaard-Klitbo, Anders ;
Tenma, Jutaka Reilin ;
Bols, Birgitte ;
Ingeholm, Peter ;
Rasmussen, Leif Ahrenst ;
Jepsen, Lars Vedel ;
Iversen, Else Refsgaard ;
Kristensen, Bent ;
Gogenur, Ismail .
LANCET ONCOLOGY, 2015, 16 (02) :161-168
[5]   Surgical technique and survival in patients having a curative resection for colon cancer [J].
Bokey, EL ;
Chapuis, PH ;
Dent, OF ;
Mander, BJ ;
Bissett, IP ;
Newland, RC .
DISEASES OF THE COLON & RECTUM, 2003, 46 (07) :860-866
[6]   Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study [J].
Bregendahl, S. ;
Emmertsen, K. J. ;
Lous, J. ;
Laurberg, S. .
COLORECTAL DISEASE, 2013, 15 (09) :1130-1139
[7]   Recurrence and survival after mesorectal excision for rectal cancer [J].
Bülow, S ;
Christensen, IJ ;
Harling, H ;
Kronborg, O ;
Fenger, C ;
Nielsen, HJ .
BRITISH JOURNAL OF SURGERY, 2003, 90 (08) :974-980
[8]   Improved survival after rectal cancer in Denmark [J].
Bulow, S. ;
Harling, H. ;
Iversen, L. H. ;
Ladelund, S. .
COLORECTAL DISEASE, 2010, 12 (07) :E37-E42
[9]  
Dahlberg M, 1998, BRIT J SURG, V85, P515
[10]   Laparoscopic Wide Mesocolic Excision and Central Vascular Ligation for Carcinoma of the Colon [J].
Ehrlich, A. ;
Kairaluoma, M. ;
Bohm, J. ;
Vasala, K. ;
Kautiainen, H. ;
Kellokumpu, I. .
SCANDINAVIAN JOURNAL OF SURGERY, 2016, 105 (04) :228-234