| Background and Objective Low anterior resection syndrome(LARS)is a common problem after rectal cancer operation.This study was designed to evaluate the incidence,prognosis and risk factors of LARS in Chinese patients with rectal cancer after sphincter-saving surgery.Pelvic diameters,especially the interspinous diameter,were evaluated against the recovery of LARS.Methods A total of 337 rectal cancer patients(208 males and 129 females,at an average age of 61.03±11.32)who underwent tumor removal with a total mesorectal excision and colorectal anastomosis in Department of General surgery,Xinqiao Hospital of the Third Military Medical University,from May 2012 to January 2015,were asked to complete the verified version of the Low Anterior Resection Score questionnaire.Clinical parameters were analyzed against the incidence of LARS.The clinical and pathological factors that may influence the occurrence of LARS were analyzed by univariate and multivariate logistic regression analysis.The influences of postoperative time and pelvic size on the occurrence of LARS were analyzed.106 rectal cancer patients(71 males and 35 females,at an average age of 62.06±11.92)from August 2014 to January 2015 were asked to complete the Low Anterior Resection Score questionnaire at 3-months,6-months and 12-months after surgery and occurrence of LARS were compared.When low rectal cancer patients were divided to two groups by the length of interspinous diameter,the occurrence of LARS were compared.Finally,the influences of pelvic measurements on the recovery of LARS were analyzed.Result The mean LARS score from these responders was 14.08(range,0~41).126 patients(37.4%)had LARS,including 63(18.7%)with major LARS.On multivariate logistic regression analysis,we found that lower locations of anastomosis,pre-surgery radiotherapy,shorter postoperative recovery time are the independent risk factors of LARS(OR>1,P<0.05).The analysis about the relationship between the postoperative recovery time and LARS score revealed that,compared with the patients in the first 6 postoperative months,the LARS score in the patients in the period of 6-18 postoperative months displayed a significant gradual decrease trend(P<0.01).In the patients with the postoperative recovery time over 18 months,low rectal cancer patients(the anastomotic site if done below 5 cm from the anal verge)had a higher incidence of LARS(P<0.05).And in those lower rectal cancer patients,interspinous diameter of LARS group were significantly lower than NO LARS group(P<0.05).Consecutively follow-up 12 months information also revealed that,compared with the patients in the first 6 postoperative months,the occurrence of LARS in the patients at the 12 postoperative months displayed a significant decrease(P<0.01).Compared with the symptoms of 3 months after surgery,the rectal cancer patients had better control of defecate,lower incidence of urgency and incomplete evacuation at 1 postoperative year.But the frequent bowel movements displayed a gradual decrease and lower than normal people at 1 postoperative year.Compared with low rectal cancer patients at 3 postoperative months,the incidence of LARS in low rectal cancer patients at 1 postoperative year displayed a significant decrease(P<0.05),on the other hand,the incidence was significantly higher than patients whose anastomotic site if done at or above 5 cm from the anal verge at 1 postoperative year.When low rectal cancer patients(the anastomotic site if done below 5 cm from the anal verge)were divided to two groups by the length of intertuberous diameter,the group with longer intertuberous diameter had a lower incidence of LARS at 1 postoperative year(P<0.05).On the contrary,there was no difference between two groups at 3 postoperative months(P>0.05);When low rectal cancer patients were divided to two groups by the significant improvement of LARS grade at 3 postoperative months and 1 postoperative year separately,both of the interspinous diameter and the intertuberous diameter of improved group were longer than those in NO improved group(P<0.05).Conclusion LARS is the common complication after sphincter-preserving surgery of rectal cancer patients,especially with the low anastomotic site.Lower locations of anastomosis,pre-surgery radiotherapy,shorter postoperative recovery time are the independent risk factors of LARS occurrence.The significant improvement of LARS symptoms could be significantly improved after at least postoperative 6 months.The interspinous diameter may be a potential predicating factor in LARS recovery of the patients with low rectal cancer. |
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