Análisis de factores asociados con el Síndrome de Resección Anterior en pacientes operados por tumores de recto. ¿Puede el cirujano prevenir su aparición?
Abstract
Background: Patients submitted to Low Anterior Resection with anastomosis for a rectal tumor, commonly suffer functional problems related with defecation, which, altogether, are known as LARS (low anterior resection syndrome). Symptoms include an increase in frequency, urgency, and clustering, as well as fecal incontinence.
Aim: To determine LARS prevalence, and factors related with its appearance and severity.
Design: Retrospective, cross-sectional, observational study.
Method: Patients submitted to low anterior resection with extraperitoneal primary anastomosis caused by confirmed/suspected rectal adenocarcinoma, not considered for endoscopic resection, performed by the same surgical staff in two institutions. A questionary on bowel function was administered to between November 2020 and April 2021. LARS score (range 0-42) and related variables were also analyzed.
Results: Between june 2012-march 2021, 268 patients with rectal neoplasms were operated. 69 met the inclusion criteria. At a median time since surgery of 31 months (3-97), 40,6% (28/69) of patients had a LARS score of 30 or more (major LARS). The risk of major LARS was significantly increased in female patients (OR 3.4, IC95% 1.08-11.8), patients who received neoadjuvant radiotherapy (OR 3.8, IC95% 1,4-10), and total versus partial mesorectal excision (OR 4.1, IC95% 1.06-15.9). There was no association with age, an anastomotic reservoir, coloanal hand-sewn anastomosis, or a temporary stoma.
Conclusions: Prevalence of major LARS in our population is similar to that reported in the literature. Radiotherapy and total mesorrectal excision constitute associated variables with a high LARS score. Still, those are mainly related with oncologic goals, rather than functional outcomes. A potentially preventive measure, such as type of anastomosis, does not appear determinant.
