使用混合效应模型的腹腔镜超低直肠癌手术后肛门功能的多中心前瞻性研究

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-05-25 DOI:10.1111/codi.70129

Makoto Takahashi, Kazuhiro Sakamoto, Yuichiro Tsukada, Shingo Kawano, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Shinobu Ohnuma, Tamuro Hayama, Koki Otsuka, Yusuke Inoue, Kazuki Ueda, Yuji Toiyama, Satoshi Maruyama, Shigeki Yamaguchi, Keitaro Tanaka, Motoko Suzuki, Toshihiro Misumi, Takeshi Naitoh, Masahiko Watanabe, Masaaki Ito, Ultimate Trial Group

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引用次数: 0

摘要

目的腹会阴切除联合永久性结肠造口术历来用于肛管附近的极低位直肠癌。肛门保留手术，如括约肌间切除术（ISR）和前低位切除术（LAR），最近变得越来越普遍。然而，在这些手术中，当吻合度很低时，术后肛门功能是一个问题。本研究的目的是研究直肠癌术后肛门功能的变化和导致肛门功能恶化的因素。方法采用2014 - 2017年Wexner评分问卷，前瞻性开展多中心（47家医院）非随机单臂II期临床试验。采用混合效应模型对278例接受腹腔镜手术治疗临床I期极低直肠癌的患者进行了分析。结果术后3个月肛门功能暂时恶化，3年后逐渐恢复，自行恢复至可接受水平。在外科手术的比较中，LAR术后肛门功能明显优于任何类型的ISR。全ISR、次ISR和部分ISR术后肛门功能差异不大。在混合效应模型分析中，ISR和年龄（≥75岁）被确定为术后肛门功能恶化的独立因素。结论肛门功能早期恶化，术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差的风险较高，在获得手术同意时应与患者沟通这些风险因素。

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A multicentre prospective study of anal function after laparoscopic ultra-low rectal cancer surgery using a mixed-effects model

Aim

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.

Method

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.

Results

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.

Conclusions

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.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.