目的:肛肠,性,排尿功能障碍是直肠癌手术后常见的问题,虽然很少探索。这项研究的主要目的是调查术后肛门直肠功能的结果。
方法:在2015年至2020年期间接受经肛门TME(TaTME)并有/没有分流造口的原发性吻合术治疗的中/低位直肠癌患者进行了回顾和选择,如果他们的最低随访时间为6个月(从主要手术或造口逆转)。使用经过验证的问卷对患者进行了访谈,主要结果是基于低位前切综合征(LARS)评分的肠功能。进行统计分析以确定与较差结果相关的临床/手术变量。计算了随机森林(RF)算法,以对处于较高的次要/主要LARS风险的患者进行分类。
结果:从154例TaTME患者中选出97例。总的来说,88.7%的患者有保护性造口,25.8%的患者在平均19.0个月的随访中报告了主要的LARS。统计分析记录了年龄,手术时间,造口逆转的间隔时间与LARS结局相关。RF分析显示,手术时间较长(>295分钟)和造口逆转间隔(>5.6个月)的患者LARS症状较差。如果间隔在3到5.6个月之间,老年患者(>65岁)的预后较差.最后,在比较前27例病例中的次要/主要LARS发生率与其他病例时,没有统计学差异.
结论:1/4的患者在TaTME后出现大的LARS。一种基于临床/手术变量的算法,比如年龄,手术时间,和造口逆转的时间,是为了识别LARS症状的风险类别而开发的。
Anorectal, sexual, and urinary dysfunction are common issues after rectal cancer surgery, although seldom explored. The primary aim of this study was to investigate postoperative anorectal functional results.
Patients with mid/low-rectal cancer treated with transanal TME (TaTME) with primary anastomosis with/without diverting stoma between 2015 and 2020 were reviewed and selected if they had a minimum follow-up of 6 months (from the primary procedure or stoma reversal). Patients were interviewed using validated questionnaires and the primary outcome was bowel function based on Low Anterior Resection Syndrome (LARS) scores. Statistical analyses were performed to identify clinical/operative variables correlated with worse outcomes. A random forest (RF) algorithm was computed to classify patients at a greater risk of minor/major LARS.
Ninety-seven patients were selected out of 154 TaTME performed. Overall, 88.7% of the patients had a protective stoma and 25.8% reported major LARS at mean follow-up of 19.0 months. Statistical analyses documented that age, operative time, and interval to stoma reversal correlated with LARS outcomes. The RF analysis disclosed worse LARS symptoms in patients with longer operative time (> 295 min) and stoma reversal interval (> 5.6 months). If the interval ranged between 3 and 5.6 months, older patients (> 65 years) reported worse outcomes. Finally, no statistical difference was documented when comparing the rate of minor/major LARS in the first 27 cases versus others.
One-quarter of the patients developed major LARS after TaTME. An algorithm based on clinical/operative variables, such as age, operative time, and time to stoma reversal, was developed to identify categories at risk for LARS symptoms.