195 Impact of anastomotic leakage after colorectal cancer surgery on quality of life: A systematic review Quality of Life up to six months after surgery Based on EORTC QLQ-CR29 and -CR30 scores at one and 6 months postoperatively, di Cristofaro et al. identified AL was an independent predictor of lower QoL in multivariate analysis (p <0.001 and p = 0.004 respectively) 19. van Kooten et al. found that patients who developed AL reported a decrease in RSCL global health status and activity level within the first three months compared to preoperative scores, with some improvement at six months 30. In contrast, Marinatou et al. did not document any improvement based on GIQLI and EORTC QLQ-C30 questionnaires administered at three and six months 24. Instead, significant decline in physical functioning, global and overall QoL scores were documented among AL patients relative to non-AL patients at six months 24. Additional results from EORTC QLQC29 demonstrated significantly worse scores with respect to pain, stoma and perianal skinrelated complaints at three and six months in AL patients. Also, SF-36 scores demonstrated significantly worse function among AL vs non-AL patients at six months, especially along emotional and social domains, which was not seen at three months. Impairment in functional outcomes based on SF-36 scores were also reported by Ashburn et al. among AL patients compared to non-AL patients after proctectomy 29. Arron et al. demonstrated that the decrease in EORTC QLQ-C30 scores observed among AL patients at 6 months relative to non-AL patients did not meet the threshold for clinical relevance, and AL status was not associated with the observed decrease. Among patients with clinically relevant decrease in their 6 months scores relative to baseline, AL was an independent predictor of this decrease based on multivariate regression analysis 22. Quality of life at 12 months after surgery Three studies reported QoL at one year following colorectal cancer resection 24, 30, 33. van Kooten et al. demonstrated that HRQoL scores returned to baseline preoperative levels among rectal cancer patients with and without complications 30, while Marinatou et al. demonstrated persistently significant differences between AL and non-AL groups for perianal skin soreness and worse overall EORTC QLQ-C30, global GIQLI and SF-36 scores 24. Ashburn et al. also documented significantly worse SF-36 scores along the PCS and MCS domains at one-year postoperatively in patients with AL compared to those without AL following restorative proctectomy 29. Beyond one year after surgery Monging et al., evaluated QoL in patients undergoing restoration of bowel continuity at least 6 months prior to the assessment 26. Given that median time of QoL assessment was 33 vs 30 months in patients with vs without AL, results were interpreted as representing longerterm QoL. No difference is SF-36 scores were found between the two groups. However, ‘blood and mucus in stool’ scores of the EORTC QLQ-CR29 indicated significantly worse function in AL patients, as did depression/self-perception FIQL scores. Ashburn et al. noted that although the SF-36 PCS scores did not show significant differences beyond 12 months postoperatively (median 3.2 years), MCS scores were still significant worse in AL patients 9
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