Ekkarat Patomphon, Boonpipattanapong Teeranut, Tantiphlachiva Kasaya, Sangkhathat Surasak
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; Tumor Biology Research Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Asian J Surg. 2016 Oct;39(4):225-31. doi: 10.1016/j.asjsur.2015.07.003. Epub 2015 Sep 2.
BACKGROUND/OBJECTIVE: Defective defecation function, also known as low anterior resection syndrome (LARS), is a common problem after surgical treatment of rectal cancer that has a detrimental effect on quality of life. This study aimed to look for the incidence of LARS in patients whose native rectum could not be kept and determine factors influencing major LARS.
Rectal cancer patients who underwent tumor removal with mesorectal excision and colorectal anastomosis by a colorectal surgeon during the years 2004-2013 were asked to participate a structured interview using the verified version of the Low Anterior Resection Score questionnaire. Clinical parameters were analyzed against the incidence of major LARS. The cut-off anastomotic level that corresponded to the risk of major LARS was calculated by using a receiver operating characteristic curve. Anorectal physiology was compared between those with major LARS and those without LARS by anorectal manometry.
This study included 129 patients (67 men and 62 women). Incidences of minor LARS (LAR score 21-29) and major LARS (LARS score ≥ 30) score 21een those with major LARS and those univariate analysis, factors associated with major LARS were extent of operation, presence of temporary ostomy, and chemoradiation therapy. Major LARS was found at 28.2% in those who underwent low anterior resection, which was significantly higher than the incidence of 5.2% in the anterior resection group (p < 0.01). Radiation therapy was the only factor independently associated with major LARS at an odds ratio of 6.55 (95% confidence interval: 2.37-18.15). The receiver operating characteristic curve plot between sensitivity and specificity of the anastomotic level in determining major LARS showed an area under the curve of 0.73. The cut-off anastomotic level that best predicted major LARS was at 5 cm, which gave a negative predictive value of 89%. Individual defecation symptoms that were significantly associated with major LARS included pain on defecation, difficulty holding stool, and needing to use a pad. Anorectal manometry showed a significant difference in the resting anal pressure and squeeze pressure, which suggests that derangement in sphincteric function caused by surgery and postoperative adjuvant treatment may contribute to the LARS.
LARS is a significant problem found in about one third of rectal cancer patients after colorectal anastomosis. Symptoms of concern include pain on defecation and decreased ability to hold. Risk of having major LARS increases with adjuvant treatment and lower anastomotic level.
背景/目的：排便功能障碍，也称为低位前切除综合征（LARS），是直肠癌手术治疗后常见的问题，对生活质量有不利影响。本研究旨在寻找无法保留原生直肠的患者中LARS的发生率，并确定影响严重LARS的因素。
要求2004年至2013年间由结直肠外科医生进行直肠系膜切除及结直肠吻合术切除肿瘤的直肠癌患者，使用经过验证的低位前切除评分问卷参与结构化访谈。分析临床参数与严重LARS发生率之间的关系。通过使用受试者工作特征曲线计算与严重LARS风险相对应的吻合口水平临界值。通过肛门直肠测压比较有严重LARS的患者和无LARS的患者之间的肛门直肠生理学情况。
本研究纳入了129例患者（67例男性和62例女性）。轻度LARS（LAR评分21 - 29）和严重LARS（LARS评分≥30）的发生率分别为......在单因素分析中，与严重LARS相关的因素包括手术范围、临时造口的存在以及放化疗。低位前切除患者中严重LARS的发生率为28.2%，显著高于前切除组5.2%的发生率（p < 0.01）。放疗是唯一与严重LARS独立相关的因素，比值比为6.55（95%置信区间：2.37 - 18.15）。吻合口水平在确定严重LARS时的敏感性和特异性之间的受试者工作特征曲线显示曲线下面积为0.73。最能预测严重LARS的吻合口水平临界值为5 cm，阴性预测值为89%。与严重LARS显著相关的个体排便症状包括排便时疼痛、憋便困难以及需要使用护垫。肛门直肠测压显示静息肛管压力和收缩压力存在显著差异，这表明手术和术后辅助治疗引起的括约肌功能紊乱可能导致LARS。
LARS是结直肠吻合术后约三分之一直肠癌患者中发现的一个重要问题。值得关注的症状包括排便时疼痛和憋便能力下降。接受辅助治疗和较低的吻合口水平会增加发生严重LARS的风险。
