Background: Rectal cancer management involves surgery, chemotherapy (CT), radiotherapy (RT), and patient care strategies, all of which significantly affect health-related quality of life (HRQoL). Understanding these effects is critical for optimizing treatment protocols. This review aimed to systematically analyze the impact of rectal cancer treatment on HRQoL. Methods: Four databases, Scopus, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials, were searched for randomized controlled trials (RCTs) published between January 2013 and December 2023. RCTs specifically focusing on rectal cancer treatments (surgical interventions, pre- and/or post-CT and/or RT, and patient care strategies) were included. An abstract review, data extraction, and a risk-of-bias assessment were independently conducted by two reviewers. Results: The 41 included studies comprised 9240 patients: 16 evaluated surgical interventions (3507 patients), 15 evaluated pre- and/or post-CT and/or RT protocols (5114 patients), and 10 focused on patient-care strategies (619 patients). Sphincter-sparing procedures were associated with better HRQoL than abdominoperineal resection, and rectal-sparing techniques were associated with better overall HRQoL than rectal resection. RT was associated with a poorer HRQoL. Continuity-of-care interventions improved HRQoL in ostomy patients, whereas transanal irrigation improved HRQoL after ostomy closure. Conclusions: This systematic review of RCTs underscores the importance of organ-sparing strategies, such as rectum-sparing approaches and continuity-of-care packages, in improving HRQoL in patients with rectal cancer. Although RT negatively affects HRQoL, treatment regimens should be individualized. Tailored organ-preservation approaches and structured follow-up care are essential for optimizing HRQoL in patients with rectal cancer.
背景：直肠癌的治疗涉及手术、化疗（CT）、放疗（RT）及患者护理策略，这些因素均显著影响健康相关生活质量（HRQoL）。了解这些影响对于优化治疗方案至关重要。本综述旨在系统分析直肠癌治疗对HRQoL的影响。方法：检索Scopus、EMBASE、MEDLINE和Cochrane对照试验中心注册库四个数据库中2013年1月至2023年12月发表的随机对照试验（RCT）。纳入专门针对直肠癌治疗（手术干预、术前和/或术后CT和/或RT，以及患者护理策略）的RCT。由两名评审员独立进行摘要筛选、数据提取和偏倚风险评估。结果：共纳入41项研究，涉及9240例患者：16项研究评估手术干预（3507例患者），15项研究评估术前和/或术后CT和/或RT方案（5114例患者），10项研究聚焦患者护理策略（619例患者）。与腹会阴联合切除术相比，保肛手术与更好的HRQoL相关；与直肠切除术相比，直肠保留技术与更好的整体HRQoL相关。放疗与较差的HRQoL相关。连续性护理干预改善了造口患者的HRQoL，而经肛门冲洗改善了造口闭合后的HRQoL。结论：本系统综述表明，器官保留策略（如直肠保留方法）和连续性护理方案对于改善直肠癌患者的HRQoL具有重要意义。尽管放疗对HRQoL有负面影响，但治疗方案应个体化。针对性的器官保留方法和结构化的随访护理对于优化直肠癌患者的HRQoL至关重要。
肿瘤(癌症)患者之家