Prospective Clinical Study Of LARS After Anus-preserving Surgery For Rectal Cancer

Background and purpose of the study:At present,surgical excision remains the most important treatment for rectal cancer.With the continuous improvement of surgical techniques and instruments,more and more patients are able to eradicate cancer while retaining anal and autonomous defecation function.However,the observation after operation found that some patients who received anus-preserving surgery for rectal cancer had different degrees of fecal dysfunction,such as fecal incontinence,constipation,fecal urgency,increased frequency of defecation,etc.These clinical symptoms have been summarized as "Low anterior resection syndrome(LARS)" in recent years.If we can control,reduce or avoid the occurrence of low anterior resection syndrome,it will greatly improve the quality of life of patients after operation,improve their confidence in life,and it is of great significance for patients to quickly re-integrate into work and life.Research methods:In this study,50 patients who underwent anus-preserving surgery for rectal cancer in the First Hospital of Jilin University were selected from January 1,2017 to January 31,2018 by prescribing an open enrollment interval.An observational study was conducted to analyze the risk factors of defecation dysfunction after anus-preserving surgery for rectal cancer.The results are as follows:There were 33 cases(66.0%)of LARS after operation in 50 patients,and 17 cases(34.0%)without LARS symptoms after operation.LARS occurred in 26 cases(52.0%)3 months after operation,including 10 cases of severe LARS(20.0%),16 cases of mild LARS(32.0%),16 cases of non-LARS(32.0%)and 8 cases of preventive ileostomy(16.0%).There were 22 cases(44.0%)of LARS 6 months after operation,including 11 cases(22.0%)of severe,11 cases(22.0%)of mild,25 cases(50.0%)of non-LARS and 3 cases(6.0%)of non-return of stoma.There were 14 cases(28.0%)of LARS 12 months after operation,of which 3 cases(6.0%)were severe,11 cases(22.0%)were mild and 36 cases(72.0%)were non-LARS.All patients with preventive fistula had undergone stoma refund.Univariate analysis showed that the distance from tumor to anal margin,the distance from anastomosis to anal margin and the recovery time after operation were significantly correlated with LARS(P < 0.05).Logisitic multivariate risk factor analysis showed that the distance from tumor to anal margin and the time of recovery after operation were independent risk factors for LARS(P < 0.05).There was no significant correlation between LARS and sex,age,degree of tumor invasion,lymph node metastasis,clinical stage,post-operative chemotherapy,prevention of fistula,length of resected intestine and length of operation(P < 0.05).Research conclusions:LARS is a common complication of anus-preserving surgery for rectal cancer,especially for low and ultra-low rectal cancer.The occurrence of LARS was significantly correlated with the distance from tumor to anal margin,the distance from anastomosis to anal margin and the recovery time after operation.The distances from the tumors to the anal margin and the recovery time after operation were independent risk factors for LARS.LARS appeared after anus-preserving surgery for rectal cancer,and the symptoms improved at least 6 months after recovery,and significantly improved at least 12 months after recovery.