The Longitudinal Course of Low-anterior Resection Syndrome An individual Patient Meta-analysis
The Longitudinal Course of Low-anterior Resection Syndrome An individual Patient Meta-analysis
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DOI：
10.1097/sla.0000000000005423
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发表时间：
2022-07-01
影响因子：
9
通讯作者：
Keane, Celia
中科院分区：
文献类型：
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作者：
Varghese, Chris;Wells, Cameron I.;Keane, Celia
目的：我们的目的是更好地了解低位前切除综合征 (LARS) 的纵向病程，以指导患者期望并识别那些存在持续功能障碍风险的患者。背景数据摘要：LARS 描述了直肠切除术后肠功能紊乱，对生活质量有显着影响。方法：系统检索了 MEDLINE、EMBASE、CENTRAL 和 CINAHL 数据库，以查找纳入接受直肠癌前切除术的成人的研究，并使用 LARS 评分评估术后 2 秒以上的肠功能时间点。对去识别的患者水平数据进行回归分析，以确定 LARS 评分从基线（3-6 个月）到 12 个月和 18-24 个月变化的预测因子。结果：纳入了 8 项研究，总共 701 名符合条件的患者。随着时间的推移，平均 LARS 评分从基线时的 29.4（95% 置信区间 28.6-30.1）提高到 36 个月时的 16.6（95% 置信区间 14.2%-18.9%）。在多变量分析中，基线和 12 个月之间平均 LARS 评分的较大改善与无回肠造口形成[平均差 (MD) -1.7 与 1.7，P < 0.001] 以及基线时存在 LARS（主要 vs 次要 vs 无 LARS）相关（MD -3.8 vs -1.7 vs 5.4，P < 0.001）。基线至 1824 个月之间平均 LARS 评分的较大改善与部分直肠系膜切除与全部直肠系膜切除相比（MD - 8.6 vs 1.5，P < 0.001）以及基线时是否存在 LARS（主要 vs 次要 vs 无 LARS）（MD -8.8 vs -5.3 vs 3.4，P < 0.001）有关。结论：术后 18 个月，LARS 改善，然后保持稳定长达 3 年。全直肠系膜切除、新辅助放疗和回肠造口术对肠道功能恢复产生负面影响。
Objective: We aimed to better understand the longitudinal course of low anterior resection syndrome (LARS) to guide patient expectations and identify those at risk of persisting dysfunction.Summary Background Data: LARS describes disordered bowel function after rectal resection that significantly impacts quality of life.Methods: MEDLINE, EMBASE, CENTRAL, and CINAHL databases were systematically searched for studies that enrolled adults undergoing anterior resection for rectal cancer and used the LARS score to assess bowel function at >= 2 postoperative time points. Regression analyses were performed on deidentified patient-level data to identify predictors of change in LARS score from baseline (3-6months) to 12-months and 18-24 months.Results: Eight studies with a total of 701 eligible patients were included. The mean LARS score improved over time, from 29.4 (95% confidence interval 28.6-30.1) at baseline to 16.6 at 36 months (95% confidence interval 14.2%-18.9%). On multivariable analysis, a greater improvement in mean LARS score between baseline and 12 months was associated with no ileostomy formation [mean difference (MD) -1.7 vs 1.7, P < 0.001], and presence of LARS (major vs minor vs no LARS) at baseline (MD -3.8 vs -1.7 vs 5.4, P < 0.001). Greater improvement in mean LARS score between baseline and 1824 months was associated with partial mesorectal excision vs total mesorectal excision (MD - 8.6 vs 1.5, P < 0.001) and presence of LARS (major vs minor vs no LARS) at baseline (MD -8.8 vs -5.3 vs 3.4, P < 0.001).Conclusions: LARS improves by 18 months postoperatively then remains stable for up to 3 years. Total mesorectal excision, neoadjuvant radiotherapy, and ileostomy formation negatively impact upon bowel function recovery.