Long-Term Functional Outcome After Early vs. Late Stoma Closure in Rectal Cancer Surgery: Sub-analysis of the Multicenter FORCE Trial.

IF 1.6 Q4 ONCOLOGY Journal of Gastrointestinal Cancer Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI:10.1007/s12029-024-01062-2

V M Meyer, N Bosch, J A G van der Heijden, A J Kalkdijk-Dijkstra, J P E N Pierie, G L Beets, P M A Broens, B R Klarenbeek, H L van Westreenen

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Abstract

Purpose: 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).

Conclusion: 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.

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直肠癌手术中早期与晚期造口关闭后的长期功能结果：多中心 FORCE 试验的子分析。

目的：本研究旨在评估早期造口关闭对直肠癌低位前切除术（LAR）后肠道功能的影响：本研究纳入了参与 FORCE 试验的患者，这些患者接受了带有保护性造口的 LAR 术。患者被细分为早期关闭组（3 个月）。本研究的终点是1年后的韦克斯纳失禁、低位前切除综合征（LARS）、EORTC QLQ-CR29和大便失禁生活质量（FIQL）评分：2017年至2020年间，38名直肠癌患者在LAR术后接受了分流造口术，可纳入研究。早期关闭组和晚期关闭组的LARS（31 vs. 30，p = 0.63）和Wexner评分（6.2 vs. 5.8，p = 0.77）无明显差异。以天为单位的造口关闭时间不能预测恢复连续性后的 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）。生活方式、应对、抑郁和尴尬等 FIQL 领域之间没有明显差异。在 EORTC QLQ-29 中，晚造口关闭组的身体形象得分更高（21.3 vs. 1.6，p = 0.004）：结论：造口关闭的时间似乎不会影响长期排便功能和生活质量，但身体形象除外。结论：除了身体形象外，造口关闭时间似乎不会影响长期肠道功能和生活质量。要改善功能结果，应重点关注其他诱因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.