Sturiale Alessandro, Martellucci Jacopo, Zurli Letizia, Vaccaro Carla, Brusciano Luigi, Limongelli Paolo, Docimo Ludovico, Valeri Andrea
General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy.
XI Division of General and Obesity Surgery, Second University of Naples, Aversa (CE), Naples, Italy.
Int J Colorectal Dis. 2017 Jan;32(1):83-88. doi: 10.1007/s00384-016-2659-6. Epub 2016 Sep 30.
This is a retrospective analysis including all of the patients that have undergone anterior resection for rectal cancer from January 1998 to December 2005 in two tertiary referral centers. The study aims to evaluate the long term functional results after low anterior resection and to identify the risk factors of postoperative bowel disorders.
Data were collected from the clinical records, and then the low anterior resection syndrome score which is a specific questionnaire to investigate the symptoms after surgery was submitted to the selected patients. Exclusion criteria were intra-abdominal rectal cancer, partial mesorectal excision, permanent stoma, recurrent local disease, and patients who declined the questionnaire.
A total of 93 patients were included in the analysis with a median age at the diagnosis of 66 years. The median follow-up was 13.7 years, and low anterior resection syndrome was reported in 44 patients (47.5 %), with major manifestations in 19 patients (20.5 %), and minor symptoms in 25 patients (27 %). Age more than 70 years, tumor distance from the external anal verge, neoadjuvant treatment, and interval time of closing stoma are independent prognostic factors of functional disorders after surgery.
Because of its great impact on the quality of life of these patients, it is necessary to early identify the syndrome trying to reduce its manifestations. Moreover, the symptoms seem to remain stable 1 year after surgery; hence, it is important to have an exhaustive, preoperative counseling and an integrated post-operative functional and rehabilitational follow-up in association with the oncologic pathway.
这是一项回顾性分析，纳入了1998年1月至2005年12月在两家三级转诊中心接受直肠癌前切除术的所有患者。本研究旨在评估低位前切除术后的长期功能结果，并确定术后肠道功能障碍的危险因素。
从临床记录中收集数据，然后向选定的患者发放低位前切除综合征评分问卷，该问卷是用于调查术后症状的特定问卷。排除标准为腹内直肠癌、部分直肠系膜切除术、永久性造口、局部疾病复发以及拒绝填写问卷的患者。
共有93例患者纳入分析，诊断时的中位年龄为66岁。中位随访时间为13.7年，44例患者（47.5%）报告有低位前切除综合征，其中19例（20.5%）有主要表现，25例（27%）有轻微症状。年龄超过70岁、肿瘤距肛缘距离、新辅助治疗以及关闭造口的间隔时间是术后功能障碍的独立预后因素。
由于其对这些患者生活质量的重大影响，有必要尽早识别该综合征以减少其表现。此外，症状在术后1年似乎保持稳定；因此，在肿瘤治疗过程中进行详尽的术前咨询以及综合的术后功能和康复随访非常重要。
