Nuytens Frederiek, Develtere Dries, Sergeant Gregory, Parmentier Isabelle, D'Hoore André, D'Hondt Mathieu
Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium.
Faculty of Medicine, KU Leuven, Leuven, Belgium.
Int J Colorectal Dis. 2018 Aug;33(8):1063-1069. doi: 10.1007/s00384-018-3043-5. Epub 2018 Apr 26.
Sphincter-preserving surgery for rectal cancer is often associated with low anterior resection syndrome (LARS). The aim of our study was to determine the prevalence of LARS in our institution and identify possible risk factors for LARS. Furthermore, we evaluated which of the LARS symptoms was considered most disabling by patients and whether or not there is an adaptation of the LARS score over time.
This study includes a prospective database of 100 patients who underwent total or partial mesorectal excision between January 2009 and September 2014. Patients were contacted after a median postoperative time of 38 (5-45) months to determine the LARS score and to identify LARS symptoms that were considered most disabling. Uni- and multivariate regression analysis was performed to identify risk factors for LARS and major LARS. Finally, the LARS score was evaluated over time after restoration of bowel continuity.
Out of the 100 patients, 16 had minor LARS (score 21-29) and 51 patients had major LARS (score 30-42). Radiotherapy was an independent risk factor for major LARS (p = 0.04). For the majority of patients with major LARS (22%), fragmentation was considered the most disabling complaint. There was no correlation between interval after restoration of bowel continuity and the severity of the LARS score.
Perioperative radiotherapy is an independent risk factor for major LARS. Fragmentation is considered the most disabling complaint in the majority of patients with major LARS. There is no significant adaptation of the LARS score over time.
直肠癌保肛手术常伴有低位前切除综合征（LARS）。本研究的目的是确定我院LARS的患病率，并找出LARS可能的危险因素。此外，我们评估了患者认为最致残的LARS症状是哪些，以及LARS评分是否会随时间而变化。
本研究纳入了一个前瞻性数据库，该数据库包含2009年1月至2014年9月期间接受全直肠系膜切除或部分直肠系膜切除的100例患者。在术后中位时间38（5 - 45）个月后联系患者，以确定LARS评分，并找出被认为最致残的LARS症状。进行单因素和多因素回归分析，以确定LARS和严重LARS的危险因素。最后，在肠道连续性恢复后，对LARS评分随时间的变化进行评估。
100例患者中，16例有轻度LARS（评分21 - 29），51例有严重LARS（评分30 - 42）。放疗是严重LARS的独立危险因素（p = 0.04）。对于大多数严重LARS患者（22%），大便不成形被认为是最致残的症状。肠道连续性恢复后的时间间隔与LARS评分的严重程度之间没有相关性。
围手术期放疗是严重LARS的独立危险因素。在大多数严重LARS患者中，大便不成形被认为是最致残的症状。LARS评分不会随时间有显著变化。
