| アブストラクト | BACKGROUND: Most patients with rectal cancer experience bowel symptoms post-restorative proctectomy. The incidence of mental health disorders post-restorative proctectomy and its association with bowel symptoms are unknown. OBJECTIVES: This study aimed 1) to describe the incidence of mental health disorders in patients who underwent restorative proctectomy for rectal cancer and 2) to study the association between incident mental health disorders and bowel dysfunction after surgery. DESIGN: This retrospective cohort study used the Clinical Practice Research Datalink and Hospital Episode Statistics databases. SETTINGS: The databases were based in the United Kingdom. PATIENTS: All adult patients who underwent restorative proctectomy for a rectal neoplasm between 1998 and 2018 were included. MAIN OUTCOME MEASURES: The primary outcome was an incident mental health disorder. The associations between bowel, sexual, and urinary dysfunctions and incident mental health disorders were studied using Cox proportional hazard regression models. RESULTS: In total, 2197 patients who underwent restorative proctectomy were identified. Of 1858 patients without preoperative bowel, sexual, or urinary dysfunction, 1455 had no preoperative mental health disorders. In this cohort, 466 patients (32.0%) developed incident mental health disorders following restorative proctectomy during 6333 person-years of follow-up. On multivariate Cox regression, female sex (adjusted HR 1.30; 95% CI, 1.06-1.56), metastatic disease (adjusted HR 1.57; 95% CI, 1.14-2.15), incident bowel dysfunction (adjusted HR 1.41, 95% CI, 1.13-1.77), and urinary dysfunction (adjusted HR 1.57; 95% CI, 1.16-2.14) were found to be associated with developing incident mental health disorders post-restorative proctectomy. LIMITATIONS: This study was limited by its observational study design and residual confounding. CONCLUSIONS: Incident mental health disorders after restorative proctectomy for rectal cancer are common. The presence of bowel and urinary functional impairment significantly increases the risk of poor psychological outcomes among rectal cancer survivors. CON LOS TRASTORNOS DE SALUD MENTAL EN PACIENTES CON CNCER DE RECTO POSTERIOR A PROCTECTOMA RESTAURADORA: ANTECEDENTES: La mayoria de los pacientes con cancer de recto experimentan sintomas intestinales despues de la proctectomia restauradora. Se desconoce la incidencia de trastornos de salud mental posteriores a la proctectomia restauradora y su asociacion con sintomas intestinales.OBJETIVOS: Los objetivos de nuestro estudio son: a) describir la incidencia de trastornos de salud mental en pacientes sometidos a proctectomia restauradora por cancer de recto; b) estudiar la asociacion entre los trastornos de salud mental incidentes y la disfuncion intestinal despues de la cirugia.DISENO: Este fue un estudio de cohorte retrospectivo que utilizo las bases de datos Clinical Practice Research Datalink y Hospital Episode Statistics.ENTORNO CLINICO: Las bases de datos se basaron en el Reino Unido.PACIENTES: Se incluyeron todos los pacientes adultos que se sometieron a una proctectomia restauradora por una neoplasia rectal entre 1998 y 2018.PRINCIPALES MEDIDAS DE VALORACION: El resultado primario fue un trastorno de salud mental incidente. Las asociaciones entre la disfuncion intestinal, sexual y urinaria y los trastornos de salud mental incidentes se estudiaron utilizando modelos de regresion de riesgos proporcionales de Cox.RESULTADOS: En total, se identificaron 2.197 pacientes que se sometieron a proctectomia restauradora. De 1.858 pacientes sin disfuncion intestinal, sexual o urinaria preoperatoria, 1.455 personas tampoco tenian trastornos de salud mental preoperatorios. En esta cohorte, 466 (32,0 %) pacientes desarrollaron trastornos de salud mental incidentes despues de la PR durante 6333 anos-persona de seguimiento. En la regresion multivariada de Cox, sexo femenino (HRa 1,30, IC 95% 1,06-1,56), enfermedad metastasica (HRa 1,57, IC 95% 1,14-2,15) e incidencia intestinal (HRa 1,41, IC del 95 %: 1,13 a 1,77) y la disfuncion urinaria (aHR 1,57, IC del 95 %: 1,16 a 2,14) se asociaron con el desarrollo de trastornos de salud mental incidentes despues de la proctectomia restauradora.LIMITACIONES: Este estudio estuvo limitado por el diseno del estudio observacional y la confusion residual.CONCLUSION: Los trastornos de salud mental incidentes despues de la proctectomia restauradora para el cancer de recto son comunes. La presencia de deterioro funcional intestinal y urinario aumenta significativamente el riesgo de malos resultados psicologicos entre los sobrevivientes de cancer de recto. (Traduccion- Dr. Ingrid Melo ). |
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| 投稿者 | Moon, Jeongyoon; Garfinkle, Richard; Zelkowitz, Phyllis; Dell'Aniello, Sophie; Vasilevsky, Carol-Ann; Brassard, Paul; Boutros, Marylise |
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| 組織名 | Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC,;Canada. Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General;Hospital; Department of Epidemiology and Biostatistics and Department of;Medicine, McGill University, Montreal, QC, Canada. |
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