Analysis Of Related Factors Associated With Anterior Resection Syndrome In Middle And Low Rectal Cancer Patients With Diverting Stoma

Aim:Surgeons may perform diverting stoma during the operation of some patients with rectal cancer who have undergone total rectal mesorectal resection to avert postoperative anastomotic fistula,yet there are more individuals with intestinal dysfunction that has had a considerable impact on their quality of life post-operation.These symptoms include defecation incontinence and frequent defecation,which are classified as "lower anterior resection syndrome ".At present,domestic and foreign studies focus on the analysis of related factors of postoperative LARS in patients with middle and low rectal cancer,but there are few analysis on the related factors of postoperative LARS in patients undergoing bypass stoma alone.An examination of the associated risk factors of LARS,such as defecation prior to sphincter-preserving surgery for rectal cancer,was conducted in this study to furnish reliable proof for the prevention and treatment of postoperative LARS in rectal cancer patients undergoing bypass stoma,thus enhancing the quality of life of those patients.Methods:This study’s criteria for inclusion and exclusion necessitated the collection of pertinent clinical data from 115 patients who had rectal cancer surgery to preserve their anus and then returned to the outpatient clinic of defecation disorder after bypass stoma,from January 2021 to June 2022,in the Department of Gastrocolostomy at the first Hospital of Jilin University.31 patients without LARS within 6 months after bypass colostomy were divided into non-LARS group and 84 patients with LARS were classified as LARS group.An examination of the associated risks of postoperative LARS in rectal cancer sufferers with a bypass stoma is conducted.Including preoperative general factors(sex,age,new adjuvant therapy),preoperative defecation abnormal factors(preoperative exhaust control disorder,preoperative rare defecation accident leakage,preoperative abnormal defecation frequency,preoperative defecation need to defecate 1 hour after defecation,preoperative defecation urgency),The anxiety and depression scale scores of preoperative patients in the hospital.The European Cancer Research and Treatment Organization Core quality of Life scale(EORTC-QLQ-C30)has been used to measure the overall quality of life,taking into account factors such as the distance from anastomosis to anal margin,the length of operation,the length of pathological specimen related to intestinal resection,the length of hospital stay,postoperative chemotherapy,and tumor-related factors such as degree of invasion,lymph node metastasis,and clinical stage.Results:Of the 115 patients included in the study,31(27.0%)were in the non-LARS group and 84(73.0%)in the LARS group.A total of 11 postoperative complications(9.6%)were reported,with one rectovaginal fistula,five anastomotic fistulas,and five intestinal obstructions.Univariate analysis revealed a correlation between gender,neoadjuvant therapy,the distance from anastomosis to anal margin,hospital anxiety and depression score factors before operation,European Cancer Research and Treatment Organization quality of life score factors(EORTC-QLQ-C30),preoperative exhaust control disorder,and accidental leakage of rare stool prior to operation and the occurrence of LARS.Multivariate analysis revealed that neoadjuvant therapy,the distance from anastomosis to anal margin less than 5cm,and preoperative exhaust control disturbance were independent risk factors for LARS.Gender,score factors of preoperative No independent risk factors for the occurrence of LARS were found to be gender,preoperative hospital anxiety and depression scale score,overall quality of life score of European Cancer Research and Treatment Organization Core quality of Life scale(EORTC-QLQ-C30),or preoperative leakage of rare stool.Conclusions:A significant correlation was observed between LARS and gender,neoadjuvant therapy,the distance from anastomosis to anal margin,hospital anxiety and depression score factors prior to operation,European Cancer Research and Treatment Organization Core quality of Life scale(EORTC-QLQ-C30),preoperative exhaust control disorder,and accidental leakage of rare stool before operation.Neoadjuvant therapy,distance from anastomosis to anal margin ≤ 5cm and disturbance of exhaust control before operation were independent risk factors for postoperative development of LARS in patients undergoing radical rectal cancer and prophylactic ostomy.