Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Université Victor Segalen, Bordeaux, France.
Dis Colon Rectum. 2011 Aug;54(8):963-8. doi: 10.1097/DCR.0b013e31821d3677.
Restoration of bowel continuity is a major goal after surgical treatment of rectal cancer. Intersphincteric resection allows sphincter preservation in low rectal cancer but may have poor functional results, including frequent bowel movements, urgency, and incontinence.
This study aimed to evaluate long-term functional outcome after intersphincteric resection to identify factors predictive of good continence.
Descriptive observational study.
Follow-up of surgery in tertiary care university hospital.
Eligible patients were without recurrence 1 year or more after surgery for low rectal cancer.
Intersphincteric resection.
: Bowel function was assessed with a standardized questionnaire sent to patients. Functional outcome was considered as good if the Wexner score was 10 or less. Univariable and multivariable regression analyses were used to evaluate impact of age, gender, body mass index, tumor stage, tumor location, distance of the tumor from the anal verge and from the anal ring, type of surgery, colonic pouch, height of the anastomosis, pelvic sepsis, and preoperative radiotherapy on functional outcome.
Of 125 eligible patients, 101 responded to the questionnaire. Median follow-up was 51 (range, 13-167) months. In multivariate analyses, the only independent predictors of good continence were distance of the tumor greater than 1 cm from the anal ring (OR, 5.88; 95% CI, 1.75-19.80; P = .004) and anastomoses higher than 2 cm above the anal verge (OR, 6.59; 95% CI, 1.12-38.67; P = .037).
The study is limited by its retrospective, observational design and potential bias due to possible differences between those who responded to the questionnaire and those who did not.
Patient characteristics do not appear to influence functional outcome at long-term follow-up after intersphincteric resection. The risk of fecal incontinence depends mainly on tumor level and height of the anastomosis.
恢复肠连续性是直肠癌手术后的主要目标。肛门内括约肌切除术允许在低位直肠癌中保留肛门括约肌，但可能会有较差的功能结果，包括频繁的排便、急迫感和失禁。
本研究旨在评估肛门内括约肌切除术后的长期功能结果，以确定预测良好控便能力的因素。
描述性观察研究。
在三级保健大学医院进行手术随访。
符合条件的患者在低位直肠癌手术后 1 年或以上无复发。
肛门内括约肌切除术。
通过向患者发送标准化问卷评估肠道功能。如果 Wexner 评分≤10，则认为功能结果良好。采用单变量和多变量回归分析评估年龄、性别、体重指数、肿瘤分期、肿瘤位置、肿瘤距肛缘和肛环的距离、手术类型、结肠袋、吻合口高度、骨盆感染和术前放疗对功能结果的影响。
在 125 名符合条件的患者中，有 101 名患者回答了问卷。中位随访时间为 51（范围，13-167）个月。多变量分析中，良好控便的唯一独立预测因素是肿瘤距肛环>1cm（比值比，5.88；95%置信区间，1.75-19.80；P=.004）和吻合口高于肛缘 2cm（比值比，6.59；95%置信区间，1.12-38.67；P=.037）。
该研究受到其回顾性、观察性设计以及由于回答问卷和未回答问卷的患者之间可能存在差异而导致的潜在偏倚的限制。
患者特征似乎不会影响肛门内括约肌切除术后的长期功能结果。粪便失禁的风险主要取决于肿瘤水平和吻合口高度。
