Zhanlong Shen1,2, Gang Yu3, Mingyang Ren4, Chao Ding5,6, Hongyu Zhang7, Shuhua Li8, Qing Xu9, Quan Wang10, Yuanguang Chen11, Zhongshi Xie12, Qingtong Zhang13, Kai Ye14, Xuedong Xu15, Jianbin Xiang16, Hong Zhang17, Su Yan18, Canrong Lu19, Hongwei Yao20, Hao Zhang21, Liang Kang22, Kewei Jiang5,6, Shan Wang5,6, Yingjiang Ye23,24. 1. Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, People's Republic of China. shenzhanlong@pkuph.edu.cn. 2. Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, People's Republic of China. shenzhanlong@pkuph.edu.cn. 3. Department of Colorectal Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266035, Shandong, People's Republic of China. 4. Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People's Republic of China. 5. Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, People's Republic of China. 6. Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, People's Republic of China. 7. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China. 8. Department of General Surgery, Zigong First People's Hospital, Zigong, 643000, Sichuan, People's Republic of China. 9. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China. 10. Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, People's Republic of China. 11. Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People's Republic of China. 12. Department of Colorectal-Anal Surgery, Third Hospital of Jilin University and Bethune Hospital, Changchun, 130033, Jilin, People's Republic of China. 13. Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, Liaoning, People's Republic of China. 14. Department of Gastrointestinal Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, People's Republic of China. 15. Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People's Republic of China. 16. Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China. 17. Department of Colorectal Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China. 18. Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, 810000, Qinghai, People's Republic of China. 19. Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China. 20. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China. 21. Department of General Surgery, Dongguan Kanghua Hospital, 1000, Dongguan, Avenue, Guangdong, People's Republic of China. 22. Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, People's Republic of China. 23. Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, People's Republic of China. yeyingjiang@pkuph.edu.cn. 24. Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, People's Republic of China. yeyingjiang@pkuph.edu.cn.
Abstract
PURPOSE: To determine the effect of transanal total mesorectal excision (taTME) procedure on the postoperative bowel evacuation function of patients with low rectal cancer. METHODS: Bowel evacuation function was investigated in 316 patients with rectal cancer after taTME in 18 hospitals in China. Low anterior resection syndrome (LARS) score, Wexner score, and EORTC QLQ-C30 were used for functional evaluation. The association between perioperative risk factors and LARS score was determined by univariate and multivariate analyses. RESULTS: The prevalence rate of no LARS, minor LARS, and major LARS in patients after taTME was 39.9%, 28.2%, and 31.9%, respectively. The two most frequently reported symptoms of LARS after taTME were bowel clustering (72.8%) and fecal urgency (63.3%). Patients with major LARS had significantly higher Wexner score and worse global health status and financial difficulties according to the EORTC QLQ-C30 questionnaire than those without major LARS. Preoperative chemoradiotherapy was an independent risk factor of major LARS occurrence after taTME (OR: 3.503, P = 0.044); existing preoperative constipation (OR: 0.082, P = 0.040) and manual anastomosis (OR: 4.536, P = 0.021) were favorable factors affecting bowel evacuatory function within 12 months after taTME, but for patients whose follow-up time was longer than 12 months, postoperative chemoradiotherapy (OR: 8.790, P = 0.001) and defunctioning stoma (OR: 3.962, P = 0.010) were independent risk factors. CONCLUSIONS: The bowel evacuation function after taTME is acceptable. Perioperative chemoradiotherapy, anastomotic method, and preoperative constipation are factors associated with bowel dysfunction after taTME.
PURPOSE: To determine the effect of transanal total mesorectal excision (taTME) procedure on the postoperative bowel evacuation function of patients with low rectal cancer. METHODS: Bowel evacuation function was investigated in 316 patients with rectal cancer after taTME in 18 hospitals in China. Low anterior resection syndrome (LARS) score, Wexner score, and EORTC QLQ-C30 were used for functional evaluation. The association between perioperative risk factors and LARS score was determined by univariate and multivariate analyses. RESULTS: The prevalence rate of no LARS, minor LARS, and major LARS in patients after taTME was 39.9%, 28.2%, and 31.9%, respectively. The two most frequently reported symptoms of LARS after taTME were bowel clustering (72.8%) and fecal urgency (63.3%). Patients with major LARS had significantly higher Wexner score and worse global health status and financial difficulties according to the EORTC QLQ-C30 questionnaire than those without major LARS. Preoperative chemoradiotherapy was an independent risk factor of major LARS occurrence after taTME (OR: 3.503, P = 0.044); existing preoperative constipation (OR: 0.082, P = 0.040) and manual anastomosis (OR: 4.536, P = 0.021) were favorable factors affecting bowel evacuatory function within 12 months after taTME, but for patients whose follow-up time was longer than 12 months, postoperative chemoradiotherapy (OR: 8.790, P = 0.001) and defunctioning stoma (OR: 3.962, P = 0.010) were independent risk factors. CONCLUSIONS: The bowel evacuation function after taTME is acceptable. Perioperative chemoradiotherapy, anastomotic method, and preoperative constipation are factors associated with bowel dysfunction after taTME.