Conversations for Providers Caring for Rectal Cancer Patients:Comparison of Long-Term Patient-Centered Outcomes for Low Rectal Cancer PatientsFacing Ostomy or Sphincter-Sparing Surgery

摘要

For some low rectal cancer patients, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients eligible for sphincter-sparing surgery may not be well served by the surgery and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries, or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects following the two surgeries has not been synthesized. We therefore conducted a systematic review to examine this ? This systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. Our goals are: 1) improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) increase the patient’s participation in the decision; (3) alert the primary careprovider to patient challenges that could be addressed by provider attention andintervention; and 4) ultimately, improve patients’ long-term quality oflife. This report includes discussion points for health care providers to usewith their patients during initial discussions of ostomy and sphincter-sparingsurgery, as well as questions to ask during follow-up examinations to ascertainany long-term challenges facing the patient.