Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3000, Bern, Switzerland.
Department of Surgery, Hirslanden Klinik Beau-Site, Bern, Switzerland.
World J Surg. 2021 Mar;45(3):873-879. doi: 10.1007/s00268-020-05876-6. Epub 2020 Dec 10.
Low anterior resection syndrome (LARS) is a defecation disorder that frequently occurs after a low anterior resection (LAR) with a total mesorectal excision (TME). The transanal (ta) TME for low rectal pathologies could potentially overcome some of the difficulties encountered with the abdominal approach in a narrow pelvis. However, the impact of the transanal approach on functional outcomes remains unknown. Here, we investigated the effect of the taTME approach on functional outcomes by comparing LARS scores between the LAR and taTME approaches in patients with colorectal cancer.
We conducted a retrospective cohort study including 80 patients (n = 40 LAR-TME, n = 40 taTME) with rectal adenocarcinoma. We reviewed medical charts to obtain LARS scores 6 months after the rectal resection or a reversal of the protective ileostomy.
At the 6-month follow-up, 80% of patients exhibited LARS symptoms (44% minor LARS and 36% major LARS). LARS scores were not significantly associated with the T-stage, N-stage, or neo-adjuvant radiotherapy. The mean distance of the anastomosis from the anal verge was 4.0 ± 2.0 cm. The taTME group had significantly lower anastomoses compared with the LAR-TME group (median 4.0 cm [IQR1.8] vs. median 5.0 cm [IQR 2.0], p < 0.001). Univariable analysis revealed significantly higher LARS scores in the taTME group compared with the LAR-TME group (median LARS scores: 29 vs. 25, p = 0.040). However, multivariable regression analysis, adjusting for neo-adjuvant treatment, anastomosis distance from the anal verge, anastomotic leak rate, and body mass index, revealed no significant effect of taTME on the LARS score (adjusted regression coefficient: - 2.147, 95%CI: - 2.130 to 6.169, p = 0.359). We also found a significant correlation between LARS scores and the distance of the anastomosis from the anal verge (regression coefficient: - 1.145, 95%CI: - 2.149 to - 1.141, p = 0.026).
Fifty percentage of patients in this cohort exhibited some LARS symptoms after a mid- or low-rectal cancer resection. As previously described, LARS scores were negatively correlated with the distance of the anastomosis from the anal verge. TaTME was after adjustment for the height of the anastomosis not associated with higher LARS at 6 months when compared with LAR-TME.
低位前切除术综合征（LARS）是一种排便障碍，常发生在全直肠系膜切除（TME）的低位前切除术（LAR）之后。经肛门（ta）TME 治疗低位直肠病变可能会克服在狭窄骨盆中进行腹部手术的一些困难。然而，经肛门入路对功能结果的影响尚不清楚。在这里，我们通过比较直肠腺癌患者的 LARS 评分，研究了 taTME 方法对功能结果的影响。
我们进行了一项回顾性队列研究，纳入了 80 例患者（n=40 LAR-TME，n=40 taTME），均患有直肠腺癌。我们查阅病历，以获得直肠切除术后 6 个月或保护性回肠造口术逆转后的 LARS 评分。
在 6 个月的随访中，80%的患者出现 LARS 症状（44%为轻度 LARS，36%为重度 LARS）。LARS 评分与 T 分期、N 分期或新辅助放疗无显著相关性。吻合口距肛缘的平均距离为 4.0±2.0cm。taTME 组的吻合口明显低于 LAR-TME 组（中位数 4.0cm [IQR1.8] vs. 中位数 5.0cm [IQR 2.0]，p<0.001）。单变量分析显示 taTME 组的 LARS 评分明显高于 LAR-TME 组（中位数 LARS 评分：29 分 vs. 25 分，p=0.040）。然而，多变量回归分析，调整新辅助治疗、吻合口距肛缘的距离、吻合口漏率和体重指数后，taTME 对 LARS 评分无显著影响（调整回归系数：-2.147，95%CI：-2.130 至 6.169，p=0.359）。我们还发现 LARS 评分与吻合口距肛缘的距离之间存在显著相关性（回归系数：-1.145，95%CI：-2.149 至-1.141，p=0.026）。
在本队列中，50%的患者在接受中低位直肠癌切除术后出现了一些 LARS 症状。与先前的描述一致，LARS 评分与吻合口距肛缘的距离呈负相关。与 LAR-TME 相比，在调整吻合口高度后，taTME 在 6 个月时与更高的 LARS 无关。
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