Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK.
Ann Surg. 2021 Dec 1;274(6):e1223-e1229. doi: 10.1097/SLA.0000000000003806.
To investigate the incidence of LARS in patients undergoing elective anterior resection within the MRC/NIHR ROLARR trial and to explore perioperative variables that might be associated with major LARS.
Sphincter-preserving rectal cancer surgery is frequently accompanied by defaecatory dysfunction known as Low anterior resection syndrome (LARS). This is distressing for patients and is an unmet clinical challenge.
An international, retrospective cohort study of patients undergoing anterior resection within the ROLARR trial was undertaken. Trial participants with restoration of gastrointestinal continuity and free from disease recurrence completed the validated LARS questionnaire between August 2015 and April 2017. The primary outcome was the incidence of LARS and secondary outcome was severity (minor versus major).
LARS questionnaires were received from 132/155 (85%) eligible patients. The median time from surgery to LARS assessment was 1065 days (range 174-1655 d). The incidence of LARS was 82.6% (n = 109/132), which was minor in 26/132 (19.7%) and major in 83/132 (62.9%). The most common symptoms were incontinence to flatus (n = 86/132; 65.2%) and defaecatory clustering (88/132; 66.7%). In a multivariate model, predictors of major LARS were: 1 cm decrease in tumor height above the anal verge (OR = 1.290, 95% CI: 1.101,1.511); and an ASA grade greater than 1 (OR = 2.920, 95% CI: 1.239, 6.883). Treatment allocation (laparoscopic vs robotic) did not predict major LARS.
LARS is a common after rectal cancer surgery and patients should be appropriately counselled preoperatively, particularly before surgery for low tumors or in comorbid populations.
在 MRC/NIHR ROLARR 试验中，调查接受择期前切除术的患者中 LARS 的发生率，并探讨可能与主要 LARS 相关的围手术期变量。
保留肛门的直肠癌手术常伴有排便功能障碍，称为低位前切除综合征（LARS）。这对患者来说是痛苦的，也是未满足的临床挑战。
对 ROLARR 试验中接受前切除术的患者进行了一项国际性、回顾性队列研究。在 2015 年 8 月至 2017 年 4 月期间，完成胃肠连续性重建且无疾病复发的试验参与者完成了经过验证的 LARS 问卷。主要结局是 LARS 的发生率，次要结局是严重程度（轻度与重度）。
从 155 名符合条件的患者中收到了 132 份 LARS 问卷（85%）。从手术到 LARS 评估的中位时间为 1065 天（范围 174-1655 天）。LARS 的发生率为 82.6%（n=109/132），轻度为 26/132（19.7%），重度为 83/132（62.9%）。最常见的症状是排气失禁（n=86/132；65.2%）和排便群集（n=88/132；66.7%）。在多变量模型中，主要 LARS 的预测因素包括：肿瘤高度距肛缘下降 1cm（OR=1.290，95%CI：1.101，1.511）；ASA 分级大于 1（OR=2.920，95%CI：1.239，6.883）。治疗分配（腹腔镜与机器人）不能预测主要 LARS。
LARS 是直肠癌手术后常见的问题，患者应在术前得到适当的咨询，特别是对于低位肿瘤或合并症患者。
