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Ileostomia, status nutricional e qualidade de vida em doentes com cancro do recto e transição recto-sigmoideia
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Background: As ileostomias são utilizadas na resseção anterior do recto para proteção das complicações graves que poderão advir da deiscência da anastomose. O objetivo deste estudo é comparar o estado nutricional e a qualidade de vida de doentes com e sem ileostomia de derivação. Métodos: É um estudo observacional, retrospetivo, de coorte. Incluiram-se doentes com e sem ileostomia de derivação, submetidos a resseção anterior do recto entre 2018 e 2020. Resultados: Analisaram-se 25 doentes (12 sem ileostomia e 13 com ileostomia). Na caracterização do estado nutricional, avaliou-se o MNA (Mini Nutritional Assessment), que indica que 50% do grupo com ileostomia se encontra em risco de desnutrição enquanto apenas 8,3% dos doentes sem estoma se encontram nessa situação. Não se observou associação do MNA com a realização de neoadjuvância ou com estádios de doença. Relativamente à avaliação do IMC (Índice de Massa Corporal), a variação deste entre o pré e pós-operatório (-8,51% no grupo com estoma e -10,37% no sem estoma), indica um comportamento semelhante entre os dois grupos, sendo que o mesmo se passa na variação de IMC do pré-operatório até à data de coleção dos dados (+2.11% com estoma e +0,70% sem ileostomia). Relativamente à qualidade de vida, os doentes com ileostomia obtiveram um valor inferior em todas as dimensões do score EORTC QOL-C30 (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core module) ainda que todas elas sem significado estatístico. Não se encontrou associção entre o resultado do EORTC QOL-C30 e a neoadjuvância ou o estádio da doença. Conclusão: Não foi possível encontrar relação entre a presença de ileostomia e o estado nutricional, no entanto, a qualidade de vida parece ser influenciada pela presença de ileostomia, sendo ainda assim, necessários mais estudos para confirmar esta hipótese.
Background: Ileostomies are often used in anterior resections of the rectum for the protection of severe complications that can accrue from anastomotic dehiscence. This study’s objective is to understand if the existence of an ileostomy influences the nutritional status or quality of life. Methods: This is a retrospective observational cohort study, in which a univariate analysis was performed. Included were patients with and without a diverting ileostomy, that have undertaken an anterior rectal resection between 2018 and 2020. Results: 25 patients were analysed (12 without ileostomy and 13 with ileostomy). In the analysis of the nutritional status, the MNA (Mini Nutritional Assessment) was evaluated, which indicates that 50% of the group with ileostomy is in risk of malnutrition, while only 8.3% of the patients without stoma are in that situation. No connection was found between the MNA value and the performance of adjuvant therapy or the stages of disease. Regarding the evaluation of the BMI (Body Mass Index), the variation obtained between the pre and post-surgery (-8.51% with a stoma and - 10.37% without a stoma), indicates a similar behaviour amongst both groups, being that the same happens in the BMI variation of the pre-surgery until the date when data was collected (+2.11% with a stoma and +0.70% without an ileostomy). Regarding the quality of life, patients with an ileostomy obtained a permanent inferior value in several dimensions of the EORTC QOL 30 score (Quality of Life Questionnaire Core module), including the global quality of life (62.12% VS 70.24%, with p-value= 0.363). No connection was found between the EORTC QOL C30 score and the performance of adjuvant therapy or the stages of disease. Conclusion: It wasn’t possible to find a correlation between the occurrence of an ileostomy and the nutritional status, however, the quality of life seems to be influenced by the occurrence of an ileostomy, but further studies are required to confirm such hypothesis.
Background: Ileostomies are often used in anterior resections of the rectum for the protection of severe complications that can accrue from anastomotic dehiscence. This study’s objective is to understand if the existence of an ileostomy influences the nutritional status or quality of life. Methods: This is a retrospective observational cohort study, in which a univariate analysis was performed. Included were patients with and without a diverting ileostomy, that have undertaken an anterior rectal resection between 2018 and 2020. Results: 25 patients were analysed (12 without ileostomy and 13 with ileostomy). In the analysis of the nutritional status, the MNA (Mini Nutritional Assessment) was evaluated, which indicates that 50% of the group with ileostomy is in risk of malnutrition, while only 8.3% of the patients without stoma are in that situation. No connection was found between the MNA value and the performance of adjuvant therapy or the stages of disease. Regarding the evaluation of the BMI (Body Mass Index), the variation obtained between the pre and post-surgery (-8.51% with a stoma and - 10.37% without a stoma), indicates a similar behaviour amongst both groups, being that the same happens in the BMI variation of the pre-surgery until the date when data was collected (+2.11% with a stoma and +0.70% without an ileostomy). Regarding the quality of life, patients with an ileostomy obtained a permanent inferior value in several dimensions of the EORTC QOL 30 score (Quality of Life Questionnaire Core module), including the global quality of life (62.12% VS 70.24%, with p-value= 0.363). No connection was found between the EORTC QOL C30 score and the performance of adjuvant therapy or the stages of disease. Conclusion: It wasn’t possible to find a correlation between the occurrence of an ileostomy and the nutritional status, however, the quality of life seems to be influenced by the occurrence of an ileostomy, but further studies are required to confirm such hypothesis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Ileostomia Qualidade de vida Cirurgia colorretal Cancro do recto Status nutricional