SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Henri DAMON
Coup de coeur :
 
 
International Journal of Colorectal Disease
  2018/08  
 
  2018 Aug;33(8):1039-1045.  
  doi: 10.1007/s00384-018-3044-4.  
 
  Late assessment of quality of life in patients with rectal carcinoma: comparison between sphincter preservation and definitive colostomy.  
 
  Silva MMRL, Junior SA, de Aguiar Pastore J, Santos ÉMM, de Oliveira Ferreira F, Spencer RMSB, Calsavara VF, Nakagawa WT, Lopes A  
  https://www.ncbi.nlm.nih.gov/pubmed/29675592  
 
 

Abstract

PURPOSE:

Patients with cancer of the lower and middle rectum who are candidates for curative surgery often have negative opinions on definitive colostomy. The purpose of this study is to compare the quality of life (QoL) of patients who undergo standard treatment for rectal cancer with sphincter preservation or definitive colostomy.

METHODS:

A total of 125 patients with adenocarcinoma of the lower or middle rectum who underwent radical surgery with curative intent with a follow-up ≥ 1 year were recruited: 83 patients (group 1) were subjected to low anterior resection and low colorectal or coloanal anastomosis-thus preserving their sphincter-and 42 (group 2) were treated with abdominoperineal resection, followed by terminal definitive colostomy. QoL was assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires.

RESULTS:

Health and global quality of life were similar between groups; however, patients who underwent definitive colostomy had higher scores on the emotional (p value = 0.016) and cognitive function scales (p value = 0.017). Patients with sphincter preservation presented with more symptoms that were related to stool frequency (p value < 0.001), intestinal constipation (p value = 0.005), fecal incontinence (p value = 0.001), buttock pain (p value = 0.023), and nausea and vomiting (p value = 0.036), whereas patients with permanent colostomy had higher scores for dysuria (p value = 0.033).

CONCLUSION:

Although global QoL scores did not differ between groups, patients who underwent definitive colostomy had significantly better functional and symptom scale scores, reflecting greater function with fewer symptoms.

 

  
Question posée
 
Objectif de cette étude brésilienne mono-centrique observationnelle : comparer la qualité de vie (QDV) des patients traités pour un cancer du rectum par résection antérieure du rectum avec préservation sphinctérienne vs ceux traités par amputation abdomino-périnéale et colostomie définitive.
  
Question posée
 
Pas de différence entre les deux groupes en termes de QDV globale. Significativement plus de symptômes (nombre des selles, incontinence fécale, constipation, nausées et vomissements..) dans le groupe préservation.
  
Commentaires

Cette étude confirme que la qualité de vie des patients ayant une colostomie est loin de l’image négative que l’on s’en fait. Il faut donc probablement aborder plus souvent cette solution thérapeutique, bien entendu avec une très grande prudence, et dans certains cas très sélectionnés.
 
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