European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2007
Patients' preferences for low rectal cancer surgery.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Bossema E, Stiggelbout A, Baas-Thijssen M, van de Velde C, Marijnen C
Аннотация
AIM: To elicit surgery preferences of patients who have experience with either low anterior resection (LAR) or abdominoperineal resection (APR) and its outcomes, to support decision-making in future patients with resectable rectal cancer.
METHODS: One hundred and twenty-two patients were interviewed. Surgery preference was assessed in two ways. In the treatment trade-off method, the certainty of a stoma was hypothetically weighed against the risk of incontinence. In the time trade-off method, remaining life expectancy was traded off to avoid a permanent stoma or faecal incontinence.
RESULTS: To avoid APR, LAR patients accepted a much higher risk of incontinence than APR patients. In fact, 71% of the LAR patients chose LAR if they would certainly suffer monthly incontinence, and still 32% if they would certainly suffer daily incontinence. Nevertheless, APR patients would give up less remaining life years to be without a permanent stoma than LAR patients to be without monthly incontinence.
CONCLUSIONS: Most patients preferred LAR above APR, even if LAR involved a risk of faecal incontinence. This seems to justify that LAR, if surgically possible, is performed in the first instance. However, since APR patients could live well with a permanent stoma, we recommend clearly informing patients before surgery about the surgical options and their potential outcomes.
METHODS: One hundred and twenty-two patients were interviewed. Surgery preference was assessed in two ways. In the treatment trade-off method, the certainty of a stoma was hypothetically weighed against the risk of incontinence. In the time trade-off method, remaining life expectancy was traded off to avoid a permanent stoma or faecal incontinence.
RESULTS: To avoid APR, LAR patients accepted a much higher risk of incontinence than APR patients. In fact, 71% of the LAR patients chose LAR if they would certainly suffer monthly incontinence, and still 32% if they would certainly suffer daily incontinence. Nevertheless, APR patients would give up less remaining life years to be without a permanent stoma than LAR patients to be without monthly incontinence.
CONCLUSIONS: Most patients preferred LAR above APR, even if LAR involved a risk of faecal incontinence. This seems to justify that LAR, if surgically possible, is performed in the first instance. However, since APR patients could live well with a permanent stoma, we recommend clearly informing patients before surgery about the surgical options and their potential outcomes.