Abstract: Objective To construct a network⁃based model of symptom clusters and quality of life in perioperative rectal cancer patients, and to explore inter⁃symptoms and their association with quality of life, providing a theoretical basis for the development of targeted symptom management strategies. Methods A total of  255 patients with rectal cancer hospitalized in the department of gastrointestinal surgery of Special Medical Center of PLA Rocket Force from November 2021 to November 2023 were enrolled by the convenience sampling method. The general information questionnaire, M.D. Anderson symptom inventory (MDASI), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ⁃C30) were used to investigate the socio⁃demographic and clinical data of rectal cancer patients as well as symptom severity and quality of life status at preoperatively(T1), 1 day postoperatively(T2), and 7 days postoperatively(T3), respectively. One⁃way ANOVA was used to assess the differences in symptoms and various domains of the quality of life in patients at each time point. The network models of symptom clusters and quality of life in the perioperative rectal cancer patients were constructed by a network⁃based analysis; core symptoms and node associations were identified by calculating node strength centrality and edge weight values. Results Except for the cognitive function domain of life quality (P=0.311), there were significant differences in patients' symptoms and life quality were statistically significant at T1, T2 and T3, respectively (all P<0.05). In the three network models, symptoms were negatively correlated with all the domains of life quality. At stage T1, the strongest correlation was between distress and social function (-0.22); at stage T2, the strongest correlation was between lack of appetite and physical function (-0.34); at stage T3, the strongest correlation was between difficulty remembering and cognitive function (-0.30). The perioperative symptom clusters of rectal cancer patients were mainly manifested as disease behavior symptoms (including shortness of breath, dry mouth, difficulty remembering, numbness), psychoneurotic symptoms (including sad, distress,drowsy, sleepy, pain, fatigue) and gastrointestinal symptoms (including lack of appetite, nausea, vomiting). According to the node strength values, shortness of breath (1.30), dry mouth (1.09), and difficulty remembering (1.03) were the core symptoms, and emotional function (1.16) was the core domain in stage T1; shortness of breath (1.42), sad (1.23), and distress (1.20) were the core symptoms, social function (1.24) was the core domain in stage T2; sad (1.45), lack of appetite (1.28 ), and drowsy (1.26) were core symptoms, while emotional function (1.25) was the core domain in stage T3. The three network models were highly stable, with network connection strength stability coefficients of 0.518, 0.561, and 0.672, respectively. Conclusions Patients with rectal cancer experience a stable cluster of disease symptoms during the perioperative period, which are strongly associated with the quality of life. It is necessary to pay attention to symptom clusters and adopt targeted management measures.

Key words: Rectal cancer, Perioperative, Symptom cluster, Quality of life, Network analysis