Zusammenfassung
Die multimodale Therapie des fortgeschrittenen Rektumkarzinoms beeinhaltet eine optimierte Chirurgie mit totaler mesorektaler Exzision, eine (neo-/adjuvante) Radiochemotherapie und/oder eine systemische Chemotherapie. Dabei ist die integrale Betrachtung von Lebensverlängerung und Lebensqualität (LQ) noch viel zu selten Grundlage der Therapieentscheidung. Ziel der vorliegenden Übersichtsarbeit ist es, verschiedene Aspekte der LQ-Bestimmung bei der chirurgischen Therapie darzustellen. Generell ist die permanente Kolostomie im Gegensatz zur anterioren Rektumresektion nicht zwangsläufig mit einer schlechten postoperativen LQ assoziiert. Die Rückverlegung einer protektiven Ileostomie erhöht bei Patienten mit Rektumkarzinom die LQ. Die laparoskopische totale mesorektale Exzision bietet in Bezug auf die LQ derzeit keine messbaren Vorteile im Vergleich zur konventionell offenen Operation. Wenn technisch möglich, bietet die Kolon-J-Pouch-Rekonstruktion messbare Vorteile der postoperativen LQ gegenüber Rekonstruktionsformen wie der geraden Anastomose und/oder der Koloplastie. Die Kenntnis der postoperativen Einschränkungen der LQ und eine konsequente präoperative Aufklärung helfen, die postoperative LQ der betroffenen Patienten zu verbessern.
Abstract
Multimodal treatment of advanced rectal cancer involves excision of the rectum in conjunction with pelvic radiotherapy and chemotherapy. Outcome assessment in oncologic surgery for rectal cancer has conventionally included data regarding perioperative mortality and morbidity, disease recurrence, and long-term survival. Throughout the past decade however research has increased in the field of patient-reported outcome, and quality of life (QoL) is now regarded as a key measurement in assessing outcomes of interventions. The aim of this review paper was to evaluate QoL assessment in different aspects of rectal surgery. In general patients undergoing abdominoperineal excision with permanent colostomy did not have poorer QoL measures than those undergoing anterior resection. Reversal of a dysfunctional loop ileostomy in surgery for low rectal cancer improves most patients’ overall QoL. The previously reported short- and long-term QoL analysis of laparoscopic vs conventional open rectal surgery revealed no significant differences. In patients undergoing restorative resection for low rectal cancer, colonic J pouches offer significant advantages in function and QoL over straight anastomosis or coloplasty.
Literatur
Aaronson NK, Ahmedzai S, Bergman B et al (1993) 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 Natl Cancer Inst 85(5):365–376
Anthony T, Hynan LS, Rosen D et al (2003) The association of pretreatment health-related quality of life with surgical complications for patients undergoing open surgical resection for colorectal cancer. Ann Surg 238(5):690–696
Bretagnol F, Rullier E, Laurent C et al (2004) Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum 47(6):832–838
Breukink SO, van Driel MF, Pierie JP et al (2008) Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision. Int J Colorectal Dis 23(12):1199–205. Epub 2008 Aug 15
Camilleri-Brennan J, Steele RJ (2002) Prospective analysis of quality of life after reversal of a defunctioning loop ileostomy. Colorectal Dis 4(3):167–171
Camilleri-Brennan J, Steele RJ (2001) Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. Br J Surg 88(12):1617–1622
Devlin HB, Plant JA, Griffin M (1971) Aftermath of surgery for anorectal cancer. Br Med J 3(5771):413–418 Links
Fazio VW, Zutshi M, Remzi FH et al (2007) A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246(3):481–490
Gosselink MP, Busschbach JJ, Dijkhuis CM et al (2006) Quality of life after total mesorectal excision for rectal cancer. Colorectal Dis 8(1):15–22
Hallböök O, Påhlman L, Krog M et al (1996) Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224(1):58–65 Links
Hassan I, Cima RR (2007) Quality of life after rectal resection and multimodality therapy. J Surg Oncol 96(8):684–692
Heuschen UA, Heuschen G, Lucas M et al (1998) Pre- and postoperative quality of life of patients with ulcerative colitis and familial adenomatous polyposis with ileoanal pouch operation. Chirurg 69(12):1329–1333
Holloway S, Sarosi G, Kim L et al (2002) Health-related quality of life and postoperative length of stay for patients with colorectal cancer. J Surg Res 108(2):273–278
Holzer B, Matzel K, Schiedeck T et al (2005) Study Group for Quality of Life in Rectal Cancer. Do geographic and educational factors influence the quality of life in rectal cancer patients with a permanent colostomy? Dis Colon Rectum 48(12):2209–2216
Hoppe De Mamani S, Schlag PM (2004) Quality of life after rectal surgery. Chirurg 75(1):26–31
Hüser N, Michalski CW, Erkan M (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248(1):52–60
Jayne DG, Guillou PJ, Thorpe H (2007) UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25(21):3061–3068
Kuhry E, Schwenk W, Gaupset R et al (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: A cochrane systematic review of randomised controlled trials. Cancer Treat Rev 34(6):498–504
Murata A, Brown CJ, Raval M, Phang PT (2008) Impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer. Am J Surg 195(5):611–615
Pachler J, Wille-Jørgensen P (2005) Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev (2):CD004323
Palmer G, Martling A, Lagergren P et al (2008) Quality of life after potentially curative treatment for locally advanced rectal cancer. Ann Surg Oncol 15(11):3109–3117
Sajid MS, Rimpel J, Iftikhar M, Baig MK (2007) Use of health related quality of life tools in colorectal surgery. Acta Chir Belg 107(6):623–629
Siassi M, Hohenberger W, Lösel F, Weiss M (2008) Quality of life and patient’s expectations after closure of a temporary stoma. Int J Colorectal Dis 23(12):1207–1212
Sprangers MA (2002) Quality-of-life assessment in oncology. Achievements and challenges. Acta Oncol 41(3):229–237
Tsunoda A, Tsunoda Y, Narita K et al (2008) Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum 51(2):218–222
Urso E, Serpentini S, Pucciarelli S et al (2006) Complications, functional outcome and quality of life after intensive preoperative chemoradiotherapy for rectal cancer. Eur J Surg Oncol 32(10):1201–1208
Whalen GF, Ferrans CE (2001) Quality of life as an outcome in clinical trials and cancer care: A primer for surgeons. J Surg Oncol 77(4):270–276
Victorson D, Barocas J, Song J, Cella D (2008) Reliability across studies from the functional assessment of cancer therapy-general (FACT-G) and its subscales: A reliability generalization. Qual Life Res 17(9):1137–1146
Wilson TR, Alexander DJ, Kind P (2006) Measurement of health-related quality of life in the early follow-up of colon and rectal cancer. Dis Colon Rectum 49(11):1692–702
Yang L, Yu YY, Zhou ZG (2007) Quality of life outcomes following laparoscopic total mesorectal excision for low rectal cancers: A clinical control study. Eur J Surg Oncol 33(5):575–579
Z’graggen K, Maurer CA, Birrer S et al (2001) A new surgical concept for rectal replacement after low anterior resection: The transverse coloplasty pouch. Ann Surg 234(6):780–787
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Germer, CT., Isbert, C. Lebensqualität nach Rektumkarzinomoperation. Chirurg 80, 316–323 (2009). https://doi.org/10.1007/s00104-008-1623-6
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DOI: https://doi.org/10.1007/s00104-008-1623-6