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    Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review

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    URI
    https://rde.dspace-express.com/handle/11287/622369
    Author
    Lawday, S.
    Flamey, N.
    Fowler, G. E.
    Leaning, M.
    Dyar, N.
    Daniels, I. R.
    Smart, N. J.
    Hyde, C.
    Date
    2021-11-09
    Journal
    BJS open
    Type
    Journal Article
    Publisher
    Wiley
    DOI
    10.1093/bjsopen/zrab101
    Rights
    © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.
    Metadata
    Show full item record
    Abstract
    BACKGROUND: Low rectal cancers could be treated using restorative (anterior resection, AR) or non-restorative procedures with an end/permanent stoma (Hartmann's, HE; or abdominoperineal excision, APE). Although the surgical choice is determined by tumour and patient factors, quality of life (QoL) will also influence the patient's future beyond cancer. This systematic review of the literature compared postoperative QoL between the restorative and non-restorative techniques using validated measurement tools. METHODS: The review was registered on PROSPERO (CRD42020131492). Embase and MEDLINE, along with grey literature and trials websites, were searched comprehensively for papers published since 2012. Inclusion criteria were original research in an adult population with rectal cancer that reported QoL using a validated tool, including the European Organization for Research and Treatment of Cancer QLQ-CR30, QLQ-CR29, and QLQ-CR38. Studies were included if they compared AR with APE (or HE), independent of study design. Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Outcomes of interest were: QoL, pain, gastrointestinal (GI) symptoms (stool frequency, flatulence, diarrhoea and constipation), and body image. RESULTS: Nineteen studies met the inclusion criteria with a total of 6453 patients; all papers were observational and just four included preoperative evaluations. There was no identifiable difference in global QoL and pain between the two surgical techniques. Reported results regarding GI symptoms and body image documented similar findings. The ROBINS-I tool highlighted a significant risk of bias across the studies. CONCLUSION: Currently, it is not possible to draw a firm conclusion on postoperative QoL, pain, GI symptoms, and body image following restorative or non-restorative surgery. The included studies were generally of poor quality, lacked preoperative evaluations, and showed considerable bias in the data.
    Citation
    BJS Open. 2021 Nov 9;5(6):zrab101. doi: 10.1093/bjsopen/zrab101.
    Publisher URL
    https://academic.oup.com/bjsopen/article-lookup/doi/10.1093/bjsopen/zrab101
    Note
    The article is available via Open Access. Click on the 'Additional link' above to access the full-text.
    Collections
    • 2022 Eastern publications
    • Colorectal (rectum, anus and colon)
    • Gastroenterology
    • HeSRU publications

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