Patients with mild polyposis coli: long term quality of life after surgery vs. endoscopy

Abstract

Background: Patients with multiple colorectal adenomas (10 to 100 polyps) have a high risk of colorectal cancer. Treatments include: endoscopic management (EM, conservative treatment) and surgical treatment (SU): segmental colectomy or hemi-colectomy (SC, less invasive treatment) or total or subtotal colectomy (TC, more invasive treatment). The aim of this study is to assess the long-term quality of life (QoL) of these patients, comparing patients who underwent different treatments, and comparing them to the general population. Methods: Design: single-centre observational study. Participants: 34 patients with ≥10 years from diagnosis (endoscopy: n=10; segmental colectomy: n = 10; total colectomy: n=14). Measures: EORTC-QLQ C30, EORTC-QLQ CR29, MSKCC questionnaire for bowel functioning. Analyses: Non-parametric tests (Mann-Whitney U test, Kruskal-Wallis test, Chi squared) and clinical differences (≥10 points) for comparison with the general population on EORTC-QLQ C30 scores. Findings: EORTC-QLQ C30: Patients have more constipation (particularly EM and SC patients) and more diarrhoea (particularly TC patients) than the general population. TC patients have significantly more diarrhoea (p=.002) and less constipation (p=.051) than the both EM and SC patients. EORTC-QLQ CR29: TC patients have significantly higher stool frequency than other patients (p<.001). MSKCC: SU patients have worse total bowel function score than EM patients (p<.001), with TC patients exhibiting worse scores than SC patients (p<.001). The same pattern was found for the frequency, dietary and urgency/soilage scales. Discussion: The differences emerged in this study pertain mainly to patients’ bowel function and symptoms related to defecation issues, with scores correlated to the invasiveness of the treatment.