Impact of minimal invasive surgery techniques on long-term health-related quality of life in rectal cancer: a Dutch cohort study
Menée à l'aide de données multicentriques néerlandaises portant sur 1 423 patients atteints d’un carcinome rectal, cette étude analyse la qualité de vie à long terme en fonction du type d'exérèse mésorectale totale (robot-assistée ou laparoscopique)
Objective: Limited data exists on health-related quality of life (HRQoL) after robot-assisted surgery (RAL) for rectal cancer beyond one-year post-surgery. This study compares long-term HRQoL following RAL total mesorectal excision (TME) to conventional laparoscopic (CL) TME.
Methods: All rectal carcinoma patients from the 63-center Prospective National CRC cohort (PLCRC) who completed pre- and post-operative HRQoL questionnaires (EQ-5D, QLQ-C30, and QLQ-CR29) were retrospectively included. Delta scores per parameter were calculated by subtracting pre-operative scores from scores at one year. Sensitivity analysis included all patients with beyond one-year post-operative questionnaires, regardless of a pre-operative questionnaire. Data were analyzed using multivariate linear regression.
Results: Patients undergoing RAL TME more often had low rectal tumors, more post-operative complications and more stomas. In patients with both pre- and post-operative questionnaires, no significant differences were found in the EQ-5D delta score (n=591). The QLQ-C30 (n=709) showed statistically significant and clinical relevant difference in fatigue favored CL TME (4.4 ± 1.9, p=0.021). The QLQ-CR29 (n=696) showed small, statistically significant differences favoring RAL in body image and stoma-related issues, but no clinical relevance. Sensitivity analysis EQ-5D (n=1250), QLQ-C30 (n=1423) or QLQ-CR29 (n=1453) showed no clinically relevant differences.
Conclusion: This is the first study comparing long-term HRQoL between CL and RAL surgery for rectal cancer. Although several statistically significant differences were found, no clinically relevant differences were observed except for a small difference in the subdomain fatigue of the EORTC QLQ-C30 favoring CL surgery. Furthermore, the current study underlines the relevance of a pre-operative HRQoL assessment.
European Journal of Surgical Oncology , résumé, 2025