Croese Alexander D, Zubair Omar N, Lonie James, Trollope Alexandra F, Vangaveti Venkat N, Mushaya Chrispen, Ho Yik-Hong
Division of General Surgery, The Townsville Hospital, Townsville, Queensland, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
ANZ J Surg. 2018 Dec;88(12):E813-E817. doi: 10.1111/ans.14749. Epub 2018 Aug 17.
With decreasing indication for abdominoperineal resection and an increase in sphincter preserving surgery, there is a growing population of patients who suffer from low anterior resection syndrome (LARS). The aim of this study is to use the LARS score to determine the prevalence of LARS at a regional centre in Australia and determine the effect of short- and long-course neoadjuvant therapy, anastomotic technique and interval from surgery will also be assessed.
Patients who had undergone an anterior resection (high, low or ultralow) at a regional centre over an 11-year period were identified. Eligible patients were contacted to complete a LARS score questionnaire. Results were analysed to determine the rate of major LARS and possible causative roles of certain patient and treatment-related variables.
A total of 64 of 76 patients (84%) returned completed questionnaires. The prevalence of major LARS was 37.5%. Short-course neoadjuvant therapy appeared to be more likely to be associated with major LARS compared to long course (odds ratio (OR) = 2.4, 95% confidence interval (CI) 0.37-15.3, P = 0.35); however, this did not reach statistical significance. Rates of major LARS appear to decrease slowly over time and J-pouch colonic anastomosis appears to be slightly protective against major LARS (OR = 0.7, 95% CI 0.12-3.9, P = 0.70); however, neither results were statistically significant.
The rate of major LARS at this regional centre is 37.5%. Larger prospective multicentre studies are required to determine impact of variables such as type of neoadjuvant therapy, anastomotic techniques and progression of LARS over time.
随着腹会阴联合切除术的适应证减少以及保肛手术的增加，患有低位前切除综合征（LARS）的患者群体不断扩大。本研究的目的是使用LARS评分来确定澳大利亚一个地区中心LARS的患病率，并确定短期和长期新辅助治疗、吻合技术以及手术间隔时间的影响。
确定在11年期间在该地区中心接受前切除术（高位、低位或超低位）的患者。联系符合条件的患者以完成LARS评分问卷。分析结果以确定严重LARS的发生率以及某些患者和治疗相关变量的可能致病作用。
76名患者中有64名（84%）返回了完整的问卷。严重LARS的患病率为37.5%。与长期新辅助治疗相比，短期新辅助治疗似乎更有可能与严重LARS相关（优势比（OR）=2.4，95%置信区间（CI）0.37 - 15.3，P = 0.35）；然而，这未达到统计学意义。严重LARS的发生率似乎随时间缓慢下降，J形袋结肠吻合术似乎对严重LARS有轻微的保护作用（OR = 0.7，95%CI 0.12 - 3.9，P = 0.70）；然而，这两个结果均无统计学意义。
该地区中心严重LARS的发生率为37.5%。需要更大规模的前瞻性多中心研究来确定新辅助治疗类型、吻合技术以及LARS随时间的进展等变量的影响。
