Jiménez-Rodríguez R M, Segura-Sampedro J J, Rivero-Belenchón I, Díaz Pavón J M, García Cabrera A M, Vazquez Monchul J M, Padillo J, de la Portilla F
Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain.
Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain.
Colorectal Dis. 2017 May;19(5):485-490. doi: 10.1111/codi.13524.
Low anterior resection syndrome (LARS) comprises a collection of symptoms affecting patients after restorative surgery for rectal cancer. The aim of the present study was to analyse the incidence of LARS in patients undergoing rectal cancer surgery with and without subsequent ileostomy and to determine whether the interval to ileostomy closure is a factor associated with its occurrence.
All patients undergoing curative anterior resection for rectal cancer from 2008 to 2012 in our institution were included in the study. They were divided into two groups according to whether or not a defunctioning ileostomy had been performed. Patients were assessed for LARS at a median interval of 23.60 ± 16.73 (12-48) months from anterior resection in those who did not have an ileostomy and at an interval of 11.31 ± 14.24 (12-60) months from closure of the ileostomy in those who did. They underwent a structured telephone interview based on a validated LARS score questionnaire. Univariate and multivariate analysis was carried out to assess possible associations between LARS and the variables studied.
There were 150 patients (93 men) of whom 54.7% had no evidence of LARS, 17.3% had minor symptoms and 28% major symptoms of LARS. Univariate analysis showed that male gender, the presence of a temporary ileostomy and neoadjuvant therapy were predisposing factors for LARS. The interval from construction of the ileostomy to its closure did not appear to be a factor associated with LARS. In multivariate analysis, male gender and preoperative neoadjuvant therapy were significant predisposing factors for LARS.
Male gender and preoperative neoadjuvant therapy are risk factors for LARS. The presence of ileostomy or time to ileostomy closure is not associated with the development of this syndrome.
低位前切除综合征（LARS）是一组影响直肠癌根治性手术后患者的症状。本研究旨在分析接受直肠癌手术且有或无回肠造口术患者中LARS的发生率，并确定回肠造口关闭间隔时间是否为与其发生相关的因素。
纳入2008年至2012年在本机构接受直肠癌根治性前切除术的所有患者。根据是否进行了转流性回肠造口术将他们分为两组。未行回肠造口术的患者在距前切除术后中位间隔23.60±16.73（12 - 48）个月时评估LARS，行回肠造口术的患者在距回肠造口关闭后11.31±14.24（12 - 60）个月时评估。他们接受了基于经过验证的LARS评分问卷的结构化电话访谈。进行单因素和多因素分析以评估LARS与所研究变量之间的可能关联。
共有150例患者（93例男性），其中54.7%无LARS证据，17.3%有轻度症状，28%有LARS重度症状。单因素分析显示，男性、存在临时回肠造口术和新辅助治疗是LARS的易感因素。从回肠造口术构建到关闭的间隔时间似乎不是与LARS相关的因素。多因素分析中，男性和术前新辅助治疗是LARS的显著易感因素。
男性和术前新辅助治疗是LARS的危险因素。回肠造口术的存在或回肠造口关闭时间与该综合征的发生无关。
