Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2023; 15(3): 163-176
Published online Mar 16, 2023. doi: 10.4253/wjge.v15.i3.163
Medium-term surgical outcomes and health-related quality of life after laparoscopic vs open colorectal cancer resection: SF-36 health survey questionnaire
Chao-Ming Hung, Kuo-Chuan Hung, Hon-Yi Shi, Shih-Bin Su, Hui-Ming Lee, Meng-Che Hsieh, Cheng-Hao Tseng, Shung-Eing Lin, Chih-Cheng Chen, Chao-Ming Tseng, Ying-Nan Tsai, Chi-Zen Chen, Jung-Fa Tsai, Chong-Chi Chiu
Chao-Ming Hung, Hui-Ming Lee, Chong-Chi Chiu, Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Chao-Ming Hung, Cheng-Hao Tseng, Ying-Nan Tsai, Chong-Chi Chiu, School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
Kuo-Chuan Hung, Department of Anesthesiology, Chi Mei Medical Center, Tainan 71004, Taiwan
Kuo-Chuan Hung, Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
Hon-Yi Shi, Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
Hon-Yi Shi, Department of Business Management, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
Hon-Yi Shi, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
Hon-Yi Shi, Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
Shih-Bin Su, Department of Occupational Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan
Shih-Bin Su, Department of Occupational Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan
Shih-Bin Su, Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan
Hui-Ming Lee, Meng-Che Hsieh, Chih-Cheng Chen, Chao-Ming Tseng, Jung-Fa Tsai, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
Meng-Che Hsieh, Department of Hematology-Oncology, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Cheng-Hao Tseng, Chih-Cheng Chen, Chao-Ming Tseng, Ying-Nan Tsai, Chi-Zen Chen, Department of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Cheng-Hao Tseng, Chao-Ming Tseng, Department of Gastroenterology and Hepatology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Shung-Eing Lin, Department of Colon and Rectal Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Jung-Fa Tsai, Department of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung 80794, Taiwan
Chong-Chi Chiu, Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan
Chong-Chi Chiu, Department of General Surgery, Chi Mei Medical Center, Liouying 73657, Taiwan
Author contributions: Hung CM and Hung KC contributed equally to this work; Hung CM, Hung KC, Lee HM, and Chiu CC designed the research study; Shi HY, Hsieh MC, Tseng CH, and Chiu CC performed the research; Tsai JF contributed analytic tools; Su SB analyzed the data and performed data validation; Chen CC, Tseng CM, Tsai YN, and Chen CZ provided critical opinion and feedback; Lin SE, proceeded language editing; Chiu CC, performed the operation, cared the patients, and obtained an IRB approval and supervision.
Supported by The Research Foundation of E-Da Cancer Hospital and E-Da Hospital, Kaohsiung, Taiwan, No. EDCHI111002 and NCKUEDA11110.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the E-Da Hospital, Kaohsiung,Taiwan (EMRP-110-082).
Clinical trial registration statement: This study is registered at www.taiwanclinicaltrials.tw/ctc/detail/23. The registration identification number is 10510-L03.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that we have no conflict of interest.
Data sharing statement: Participants gave informed consent for data sharing.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chong-Chi Chiu, MD, Professor, Surgeon, Department of General Surgery, E-Da Cancer Hospital, I-Shou University, No. 21 Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung 82445, Taiwan. chiuchongchi@gmail.com
Received: November 2, 2022
Peer-review started: November 2, 2022
First decision: November 18, 2022
Revised: December 12, 2022
Accepted: March 1, 2023
Article in press: March 1, 2023
Published online: March 16, 2023
Processing time: 133 Days and 22.8 Hours
Abstract
BACKGROUND

Previous studies that compared the postoperative health-related quality of life (HRQoL) outcomes after receiving laparoscopic resection (LR) or open resection (OR) in patients with colorectal cancer (CRC) have different conclusions.

AIM

To explore the medium-term effect of postoperative HRQoL in such patients.

METHODS

This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups. HRQoL was assessed during the preoperative period and 3, 6, and 12 mo postoperative using a modified version of the 36-Item Short Form (SF-36) Health Survey questionnaire, emphasizing eight specific items.

RESULTS

This cohort randomly assigned 541 patients to receive LR (n = 296) or OR (n = 245) surgical procedures. More episodes of postoperative urinary tract infection (P < 0.001), wound infection (P < 0.001), and pneumonia (P = 0.048) were encountered in the OR group. The results demonstrated that the LR group subjectively gained mildly better general health (P = 0.045), moderately better physical activity (P = 0.006), and significantly better social function recovery (P = 0.0001) 3 mo postoperatively. Only the aspect of social function recovery was claimed at 6 mo, with a significant advantage in the LR group (P = 0.001). No clinical difference was found in HRQoL during the 12 mo.

CONCLUSION

Our results demonstrated that LR resulted in better outcomes, including intra-operative blood loss, surgery-related complications, course of recovery, and especially some health domains of HRQoL at least within 6 mo postoperatively. Patients should undergo LR if there is no contraindication.

Keywords: Health-related quality of life; Medium-term result; Laparoscopic; Open surgery; Non-metastatic colorectal cancer

Core Tip: Previous randomized controlled trials that compare laparoscopic (LR) and open resection (OR) in colorectal cancer (CRC) management have led to different conclusions regarding the health-related quality of life (HRQoL). Our study analyzed the objective surgical outcomes and subjective HRQoL in 541 patients with non-metastatic CRC randomized to the LR (n = 296) or OR (n = 245) group operated by one surgeon. Better HRQoL was noticed in the LR group in general health, physical activity, and social function recovery with various degrees. These patients should consider LR to gain better HRQoL if not contraindicated because these two operative methods resulted in similar cancer-oriented outcomes and survival.