Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome
Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome
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DOI：
10.1007/s00384-017-2765-0
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发表时间：
2017-05-01
影响因子：
2.8
通讯作者：
Morris, Chris
中科院分区：
文献类型：
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作者：
Hughes, Daniel Ll;Cornish, Julie;Morris, Chris
手术技术和新辅助治疗的发展使越来越多的直肠癌患者能够接受保肛切除术。避免永久性造口可能会以肠功能不良为代价，这会显著影响患者的生活质量。本研究的目的是确定直肠癌手术后肠功能障碍的发生率和危险因素，2009年1月至2015年1月期间接受直肠癌前切除术的患者来自单一中心的直肠癌数据库。所有恢复肠道连续性并接受治愈性切除的患者都收到了一份经过验证的低位前切除综合征（LARS）调查问卷。采用条件Logistic回归分析比较了严重LARS患者与轻微或无LARS患者的术前、术中和术后因素，有效率为80%（n = 68）。38例患者（56%）有主要LARS症状。新辅助放疗，主要是长疗程放化疗（LCCRT），是主要LARS症状发展的独立危险因素，而6个月内恢复肠道连续性是保护性的。新辅助放疗（LCCRT）的使用和造口逆转的时间是严重肠功能障碍发展的危险因素。应与患者讨论LCCRT后长期功能不良结果的可能性，并将其作为个体治疗计划决策的一部分。如果安全可行，回肠造口闭合的时间应在6个月内进行，以改善结局。
Developments in surgical techniques and neoadjuvant treatment have enabled an increasing proportion of patients with rectal cancer to undergo sphincter-sparing resections. The avoidance of a permanent stoma can come at the cost of poor bowel function which can significantly impact patients' quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal cancer surgery.Patients undergoing anterior resection for rectal cancer between January 2009 and January 2015 were identified from a rectal cancer database at a single centre. All patients who had bowel continuity restored and underwent curative resection were sent a validated low anterior resection syndrome (LARS) questionnaire. Pre-, inter- and postoperative factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression.There was an 80% response rate (n = 68). Thirty-eight patients (56%) had major LARS symptoms. Neoadjuvant radiotherapy, predominantly long-course chemoradiotherapy (LCCRT), was an independent risk factor for development of major LARS symptoms, while restoration of bowel continuity within 6 months was protective.The use of neoadjuvant radiotherapy (LCCRT) and timing of stoma reversal are risk factors for the development of severe bowel dysfunction. The potential for long-term poor functional results after LCCRT should be discussed with patients and form a part of the decision-making in individual treatment plans. The timing of the ileostomy closure, where safe and feasible, should be performed within 6 months to improve outcome.