Incidence and Outcomes of Low Anterior Resection Syndrome in Patients Undergoing Preventive Ostomy for Laparoscopic Rectal Cancer Surgery.

IF 0.9 4区 医学 Q3 SURGERY
Guizhi Luo, Jinhong Lu, Youzhuan Yang, Hongchao Ma
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引用次数: 0

Abstract

Aim: This study aimed to explore the incidence and risk factors of low anterior resection syndrome (LARS) in patients undergoing preventive colostomy following laparoscopic rectal cancer surgery. Additionally, the outcomes of LARS were analyzed to provide evidence for effective prevention and treatment strategies.

Methods: The medical records of 143 patients with laparoscopic rectal cancer who underwent preventive ostomy at the Zhujiang Hospital of Southern Medical University between January 2020 and October 2022 were retrospectively reviewed. All patients underwent ostomy reversal within 2 to 6 months post-surgery. The LARS score scale was used to evaluate the occurrence of LARS at 3, 6, and 12months post-surgery. Based on LARS scores, patients were divided into LARS and non-LARS groups. Clinical characteristics, including gender, TNM stage, and other related data, were compared between the two groups. Multivariate logistic regression analysis was conducted to identify risk factors for LARS, and the predictive performance of the regression model was evaluated using the receiver operating characteristic (ROC) curve.

Results: The LARS score demonstrated a significant decrease over time after surgery (p < 0.05). LARS was identified in 80 patients (55.94%) at 3 months post-surgery, with no new cases reported after this period. Statistically significant differences between the LARS and non-LARS groups were observed in body mass index (BMI), tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal (p < 0.05). The ROC curve analysis revealed that the logistic regression model predicting LARS had an area under the curve (AUC) of 0.809 (95% CI: 0.735-0.870), with a sensitivity of 76.25% and a specificity of 79.37%. Among the LARS patients 3 months post-surgery, 73.75% (59/80) showed improvement by 12 months. The improvement rate in patients with mild LARS (87.93%) was significantly higher than in those with severe LARS (36.36%) (p < 0.05).

Conclusions: The incidence of LARS is relatively high in patients undergoing preventive ostomy after laparoscopic rectal cancer surgery. Key factors associated with LARS include BMI, tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal. Over time, the incidence of LARS decreases, and outcomes improve, especially in patients with mild LARS.

腹腔镜直肠癌预防性造口术患者低前切除术综合征的发生率和预后。
目的:探讨腹腔镜直肠癌术后行预防性结肠造口术患者低位前切除术综合征(LARS)的发生率及危险因素。此外,我们还分析了LARS的结果,为制定有效的预防和治疗策略提供证据。方法:回顾性分析2020年1月至2022年10月南方医科大学珠江医院行预防性造口术的143例腹腔镜直肠癌患者的病历。所有患者术后2 ~ 6个月内均行造口术逆转。采用LARS评分量表评估术后3、6、12个月的LARS发生情况。根据LARS评分将患者分为LARS组和非LARS组。比较两组患者的临床特征,包括性别、TNM分期等相关资料。采用多因素logistic回归分析确定LARS的危险因素,并采用受试者工作特征(ROC)曲线评价回归模型的预测性能。结果:术后LARS评分随时间的延长明显降低(p < 0.05)。术后3个月,80例(55.94%)患者发现LARS,此后无新病例报告。LARS组与非LARS组在体重指数(BMI)、肿瘤距肛缘距离、术后吻合口瘘、造口逆转时间等方面比较,差异均有统计学意义(p < 0.05)。ROC曲线分析显示,预测LARS的logistic回归模型曲线下面积(AUC)为0.809 (95% CI: 0.735 ~ 0.870),敏感性为76.25%,特异性为79.37%。术后3个月LARS患者中,73.75%(59/80)的患者在12个月后有改善。轻度LARS的治愈率(87.93%)显著高于重度LARS的治愈率(36.36%)(p < 0.05)。结论:腹腔镜直肠癌术后行预防性造口术患者LARS发生率较高。与LARS相关的关键因素包括BMI、肿瘤离肛缘的距离、术后吻合口瘘和造口逆转的时机。随着时间的推移,LARS的发病率降低,结果改善,尤其是轻度LARS患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.90
自引率
12.50%
发文量
116
审稿时长
>12 weeks
期刊介绍: Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.
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