Jimenez-Gomez Luis Miguel, Espin-Basany Eloy, Trenti Loris, Martí-Gallostra Marc, Sánchez-García José Luis, Vallribera-Valls Francesc, Kreisler Esther, Biondo Sebastiano, Armengol-Carrasco Manuel
Colorectal Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Unit of Coloproctology, Service of General Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain.
Colorectal Dis. 2017 Sep 29. doi: 10.1111/codi.13901.
To assess factors independently associated with low anterior resection syndrome (LARS) following resection or rectal cancer.
Cross-sectional study carried out in two acute-care teaching hospitals in Barcelona, Spain. Patients who had undergone sphincter preserving low anterior resection with curative intent, with total or partial mesorectal excision (with and without protective ileostomy) between January 2001 and December 2009 completed a self-administered questionnaire to assess bowel dysfunction after rectal cancer surgery. Predictors of LARS were assessed by univariate and multivariate analyses.
The questionnaire was sent to 329 patients (response rate 57.7%). Six cases of incomplete questionnaires were excluded. The study population included 184 patients (66.8% men) with a mean age of 63 years. There were 44 (23.9%) patients with no LARS, 36 (19.6%) with minor LARS and 104 (56.2%) with major LARS. In the univariate analysis, total mesorectal excision (P = 0.0008), protective ileostomy (P = 0.002), preoperative and postoperative radiotherapy (P = 0.0000), postoperative chemotherapy (P = 0.0046) and age (P = 0.035) were significantly associated with major LARS, whereas in the multivariate analysis, total mesorectal excision (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.02-4.65), preoperative radiotherapy (OR 4.33, 95% CI 2.03-9.27) and postoperative radiotherapy (OR 9.52, 95% CI 1.74-52.24) were independent risk factors for major LARS.
In this study, the risk of having major LARS increases with total mesorectal excision and both neoadjuvant and adjuvant radiotherapy. This article is protected by copyright. All rights reserved.
评估直肠癌切除术后与低位前切除综合征（LARS）独立相关的因素。
在西班牙巴塞罗那的两家急症教学医院开展横断面研究。2001年1月至2009年12月期间接受了旨在根治的保留括约肌低位前切除术、全直肠系膜切除或部分直肠系膜切除（有或无预防性回肠造口术）的患者完成了一份自我管理问卷，以评估直肠癌手术后的肠道功能障碍。通过单因素和多因素分析评估LARS的预测因素。
问卷发送给了329名患者（回复率57.7%）。排除6份不完整问卷。研究人群包括184名患者（66.8%为男性），平均年龄63岁。无LARS的患者有44名（23.9%），轻度LARS的患者有36名（19.6%），重度LARS的患者有104名（56.2%）。在单因素分析中，全直肠系膜切除（P = 0.0008）、预防性回肠造口术（P = 0.002）、术前和术后放疗（P = 0.0000）、术后化疗（P = 0.0046）和年龄（P = 0.035）与重度LARS显著相关，而在多因素分析中，全直肠系膜切除（比值比[OR] 2.18，95%置信区间[CI] 1.02 - 4.65）、术前放疗（OR 4.33，95% CI 2.03 - 9.27）和术后放疗（OR 9.52，95% CI 1.74 - 52.24）是重度LARS的独立危险因素。
在本研究中，全直肠系膜切除以及新辅助和辅助放疗均会增加发生重度LARS的风险。本文受版权保护。保留所有权利。
