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Identifier 000440693
Title Αξιολόγηση της λήψης απόφασης και της ποιότητας ζωής του ασθενή στην επιλογή χειρουργικής θεραπείας καρκίνου ορθού με διορθική ενδοσκοπική μικροχειρουργική TEMS
Alternative Title Assessment of patient decision making and quality of life in choice of rectal tumours therapy by TEMS surgery
Author Κορέλη, Αλεξάνδρα Λ.
Thesis advisor Μπριασούλης, Γεώργιος
Reviewer Φιλαλήθης, Αναστάσιος
Παπαγρηγοριάδης, Σάββας
Τσίου, Χρυσούλα
Χαραλαμπόπουλος, Ανέστης
Ηλία, Σταυρούλα
Τσιλιγιάννη, Ιωάννα
Abstract Colorectal cancer (CRC) is the third most common cancer in men and second in women, globally, with the highest incidence of 44% in people over 75 years of age, and survival rates around 60% for 10 years or more for rectal cancer alone. Rectal cancer (RC) is an important subgroup of colorectal cancer (CRC): it may result from different gene alterations and its treatment is surgically more challenging. The “gold standard” of RC treatment is total mesorectal excision (TME) by either low anterior resection (LAR) or by abdominoperineal resection (APR) of the rectum with temporary ileostomy or a permanent stoma, respectively. An alternative to TME is the minimally invasive transanal endoscopic microsurgery (TEMS), which was introduced by Buess in the early 1980s for selected early rectal cancers (ERC). The advantages of TEMS, apart from preserving the sphincters and the rectal function, are fast recovery and a shorter hospitalization (average 2 days) with much lower morbidity and mortality than LAR and APR. The TEMS technique for ERC was shown to be safe with low local recurrence, high survival rates and equal oncological results with radical surgery. Hence, the decision regarding treatments that are similar in clinical and oncological outcomes rely on patient experience and QoL following treatment. Furthermore, in older and frail patients the surgical trauma should be kept to a minimum with organ preservation, aiming for functional advantages and better QoL. Only few studies have addressed the QoL after TEMS with small samples and followup up to one year in most cases. Nonetheless, it is not clear what QoL patients have after TEMS, and to which extend it justifies their treatment decision. Patient involvement in treatment decisions is fundamental in modern health care and known to be beneficial to patient experience. To the best of our knowledge, there is no literature regarding factors influencing patient decision making towards the TEMS option against radical surgery. Objective: To explore the factors affecting patients’ decision-making concerning the choice of surgical treatment as well as to measure the Quality of Life (QoL) post-Transanal endoscopic microsurgery (TEMS) Design: Cross-sectional study Setting: Colorectal Department, King’s College Hospital, regional referral centre for TEMS. Patients and Methods: Patients with rectal cancer stage T1/T2 -N0-M0 that underwent TEMS were studied. The questionnaires used included the Short Form SF12v2, Wexner Score (CCF-FIS) and the Sexual Function Questionnaire (SFQ). The patients’ views on experience and treatment decision were obtained with a custom-designed questionnaire. Questionnaires were completed at a mean of 6.9 years following treatment. Outcome measures: Quality of Life, patients’ experience of TEMS therapy, patients’ views on decision-making on TEMs choice. Results: The factors that influenced the patients’ decisions were experience satisfaction (p=0.003), postoperative bowel function (p<0.001), lower incontinence score (p=0.020) and the agreement of TEMS experience with preoperative information (p=0.049). Treatment experience satisfaction was associated with family support (p=0.034) and the agreement with preoperative information (p=0.047); it correlated with bowel function (p=0.026) and mental QoL (MCS) (p=0.003) as well. Both physical and mental QoL were similar to the general population and were inversely associated with the level of continence Wexner score (r=-0.40 p=0.019 and r=- 0.38 p=0.025), respectively. Continence level (Wexner score) was good with mean equal to 3.97 (SD=3.89). Sexual functioning overall was correlated with better physical QoL (p=0.014) and in reverse with increasing age (p=0.006). Patients reported less problems when having better mental QoL (p=0.030). Postoperative pain was rated low with mean 3.1 (3.3) on a scale 0-10, whilst less postoperative pain was associated with family support (p=0.009). Conclusion: Factors important to patients, when reflecting on treatment experience, are adequate and reliable information, a good QoL, and the presence of family support. Clinicians should incorporate those parameters in their practice when assisting patients in making a surgical treatment choice and provide informed consent on TEMS for rectal cancer.
Language Greek
Subject Decision-making
Rectal cancer
Καρκίνος Ορθού
Τοπική εκτομή
Issue date 2021-07-30
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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