Takahashi Makoto, Sakamoto Kazuhiro, Tsukada Yuichiro, Kawano Shingo, Watanabe Jun, Fukunaga Yosuke, Hirano Yasumitsu, Hamamoto Hiroki, Yoshimitsu Masanori, Horie Hisanaga, Matsuhashi Nobuhisa, Kuriu Yoshiaki, Nagai Shuntaro, Hamada Madoka, Yoshioka Shinichi, Ohnuma Shinobu, Hayama Tamuro, Otsuka Koki, Inoue Yusuke, Ueda Kazuki, Toiyama Yuji, Maruyama Satoshi, Yamaguchi Shigeki, Tanaka Keitaro, Suzuki Motoko, Misumi Toshihiro, Naitoh Takeshi, Watanabe Masahiko, Ito Masaaki
Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
Colorectal Dis. 2025 May;27(5):e70129. doi: 10.1111/codi.70129.
Abdominoperineal resection with permanent colostomy has historically been performed for very low rectal cancer located near the anal canal. Anus-preserving surgeries, such as intersphincteric resection (ISR) and low anterior resection (LAR), have recently become more common. However, postoperative anal function is a concern in these surgeries when the anastomosis is very low. The aim of this study was to examine changes in anal function and factors that worsen anal function after surgery for rectal cancer.
A multicentre (47 facilities), non-randomized, single-arm phase II trial was conducted prospectively using the Wexner score questionnaire between 2014 and 2017. A total of 278 patients who underwent laparoscopic surgery for clinical Stage I very low rectal cancer were analysed using a mixed-effects model.
Anal function temporarily worsened 3 months after surgery, but gradually recovered and spontaneously returned to an acceptable level in 3 years. In a comparison of surgical procedures, anal function was significantly better after LAR than after any type of ISR. There was little difference in anal function after total ISR, subtotal ISR and partial ISR. In the mixed-effects model analysis, ISR and older age (≥75 years) were identified as independent factors that worsened postoperative anal function.
The results showed early deterioration of anal function followed by gradual improvement to an acceptable level after surgery. There is a higher risk of poor postoperative anal function after ISR and in older patients, and these risk factors should be communicated to patients when obtaining consent for the surgery.
腹会阴联合切除术加永久性结肠造口术历来用于治疗靠近肛管的极低位直肠癌。诸如括约肌间切除术（ISR）和低位前切除术（LAR）等保肛手术近来变得更为常见。然而，当吻合口位置极低时，这些手术中的术后肛门功能是一个令人担忧的问题。本研究的目的是检查直肠癌手术后肛门功能的变化以及使肛门功能恶化的因素。
在2014年至2017年期间，前瞻性地开展了一项多中心（47家机构）、非随机、单臂II期试验，使用韦克斯纳评分问卷。对总共278例接受腹腔镜手术治疗临床I期极低位直肠癌的患者采用混合效应模型进行分析。
肛门功能在术后3个月暂时恶化，但逐渐恢复，并在3年内自发恢复到可接受水平。在手术方式的比较中，LAR术后的肛门功能明显优于任何类型的ISR术后。全层ISR、次全层ISR和部分ISR术后的肛门功能差异不大。在混合效应模型分析中，ISR和高龄（≥75岁）被确定为术后肛门功能恶化的独立因素。
结果显示术后肛门功能早期恶化，随后逐渐改善至可接受水平。ISR术后和老年患者术后肛门功能不良的风险较高，在获得手术同意时，应将这些风险因素告知患者。
