Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases

Yu Pu; Yuan Qiu; Xiang Li; Wensheng Wang; Hua Yang; Weidong Xiao

doi:10.16016/j.1000-5404.201611130

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Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases

Clinical Medicine | 更新时间：2026-02-09

- Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases
- Journal of Third Military Medical University Vol. 39, Issue 10, Pages: 1025-1030(2017)
- 作者机构：
  
  400037 重庆，第三军医大学新桥医院普通外科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201611130
  CLC： R619;R730.56;R735.37
- Received：15 November 2016，
  
  Revised：2017-01-01，
  
  Published：30 May 2017
- 稿件说明：
移动端阅览
Yu Pu, Yuan Qiu, Xiang Li, et al. Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases[J]. Journal of Third Military Medical University, 2017, 39(10): 1025-1030.
DOI：

Yu Pu, Yuan Qiu, Xiang Li, et al. Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases[J]. Journal of Third Military Medical University, 2017, 39(10): 1025-1030. DOI： 10.16016/j.1000-5404.201611130.

摘要

目的

探讨直肠癌患者保肛术后低位前切除综合征(low anterior resection syndrome，LARS)的发生率、恢复情况及影响因素。

方法

回顾性分析2012年5月至2015年1月第三军医大学新桥医院普通外科确诊为直肠癌并行保肛根治术的患者337例，其中男性208例，女性129例，年龄(61.03±11.32) 岁。收集患者临床、病理及随访资料，选择可能对直肠癌保肛术后LARS发生产生影响的临床病理因素进行单因素及多因素Logistic回归分析，并分析术后恢复时间及骨盆径线对LARS的影响。

结果

337例直肠癌患者LARS评分均数为14.08(0~41)，126例(37.4%)有LARS症状，其中重度LARS占总例数的18.7%。多因素Logistic回归分析显示：吻合口位置越低、术前放疗、术后恢复时间越短均是患者术后存在LARS的独立危险因素(

＞1，

0.05)。术后不同时间段的直肠癌患者LARS评分比较显示：与术后6个月内比较，术后6~18个月LARS评分呈逐步且显著下降的趋势(

0.01)。对于手术18个月后的患者研究显示：吻合口距肛缘＜5 cm直肠癌患者LARS发生率显著高于吻合口距肛缘≥5 cm组(

0.05)；骨盆径线资料对比分析发现，吻合口距肛缘＜5 cm直肠癌患者中，LARS组坐骨棘间径显著小于无LARS组(

0.05)。

结论

LARS是直肠癌特别是低位直肠癌保肛术后的常见并发症，吻合口位置、术前放疗及术后恢复时间均为影响LARS发生发展的重要因素；直肠癌患者术后LARS症状出现显著改善至少需6个月以上；骨盆横径特别是坐骨棘间径大小可预测低位直肠癌术后LARS发生及恢复情况。

Abstract

Objective

To evaluate the incidence

prognosis and risk factors of low anterior resection syndrome (LARS) in Chinese patients undergoing sphincter-preserving surgery for rectal cancer.

Methods

A total of 337 patients with rectal cancer (including 208 male and 129 female patients with a mean age of 61.03±11.32 years) undergoing total mesorectal excision and colorectal anastomosis between May 2012 and January 2015 were asked to complete a verified version of the Low Anterior Resection Score questionnaire. The clinical and pathological factors that may influence the occurrence of LARS were analyzed using univariate and multivariate logistic regression analysis. The influence of postoperative recovery time and pelvic size on the occurrence of LARS was analyzed.

Results

The mean LARS score of the patients was 14.08 (range 0~41). A total of 126 patients (37.4%) developed LARS after the surgery

including 63 (18.7%) severe cases. Multivariate logistic regression analysis identified lower locations of anastomosis

pre-surgery radiotherapy

and shorter postoperative recovery time as independent risk factors of LARS (

0.05). Compared with the scores within the initial 6 postoperative months

the LARS scores of the patients in 6~18 months after the surgery showed significant and progressive reductions (

0.01). At 18 months after the surgery

the patients with low rectal cancer (anastomotic site

5 cm from the anal verge) had a significantly higher incidence of LARS (

0.05)

and those who developed LA

RS were found to have a significantly shorter interspinous distance than those without LARS (

0.05).

Conclusion

LARS is a common complication after sphincter-preserving surgery for rectal cancer

especially in patients with a low anastomotic site. Lower locations of anastomosis

pre-operative radiotherapy

and shorter postoperative recovery time are independent risk factors of LARS occurrence. LARS symptoms can be significantly improved after at least 6 months after the surgery. The interspinous distance may serve as a potential predisposing factor that affects LARS occurrence and recovery in patients with low rectal cancer.

关键词

Keywords

references

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