Analysis Of The Influencing Factors Of LARS After Laparoscopic Radical Resection Of Rectal Cancer

Background and ObjectiveRectal cancer is a common malignant tumor of the intestine in our country.Its incidence and death rate are increasing year by year,which seriously damages people’s health.The average age of patients diagnosed with rectal cancer is 40-50years old.According to world epidemiological data,the incidence of rectal cancer is relatively high in Western developed countries,but relatively low in Asia and Africa.The cause of rectal cancer is related to many factors,such as diet,environment,genetics and so on.The treatment of rectal cancer is still a comprehensive treatment plan based on radical resection,supplemented by radiotherapy and chemotherapy.The increasing proficiency of laparoscopic surgery and the wide recognition of the principle of total mesorectal excision(TME)have made rectal cancer patients’protection The anal rate and long-term survival rate have been significantly improved,but some patients have a series of defecation dysfunctions such as fecal incontinence,tenesmus,urgency and increased frequency of defecation after anal-preserving radical surgery.We call it low anterior resection syndrome(low anterior resection).syndrome,LARS).Some patients choose permanent fistula because they cannot tolerate the change in bowel function.Some patients may have this change in bowel function for life,which has serious consequences for the quality of life,mental health,and social activities of postoperative patients.damage.Based on the above background,this study analyzed the incidence of LARS and related risk factors after laparoscopic radical anus-preserving resection of rectal cancer.Materials and methodsA retrospective analysis method was used to continuously include patients who underwent laparoscopic anus-preserving radical resection of rectal cancer at the General Surgery Department of the Second Affiliated Hospital of Zhengzhou University from September 1,2018 to December 31,2019.All patients strictly followed the procedure during the operation Principles of total mesorectal resection(TME).Post-operative follow-up visits were made to patients through four methods:telephone,We Chat,outpatient service and hospitalization.The return visit time is 6months and 12 months after surgery to avoid the influence of drugs,diet and pain on the patient’s defecation function in a short period of time after surgery.The results of all questionnaires are completed by the author himself.The general situation and defecation situation of the research object are asked in the order of the research form in the way of questioning.When asking questions,you should choose a way that is easy for the patient to understand and fill in the survey based on the patient’s answers and professional knowledge.table.After completing the questionnaire,it is necessary to check with the patient again to ensure the accuracy of the postoperative defecation function assessment of the patient.The study subjects were divided into LARS group(0-20 points)and no LARS group(21-42 points)according to the patient’s score.Through the analysis of the clinical data of the two groups,the relevant risk factors affecting its occurrence were explored.ResultsA total of 84 patients were included in this study,of which 47 were males and 37were females;the average age was(59.75±12.28)years,of which 39 were≥60 years old and 45 were<60 years old;the average tumor diameter was(4.32±1.25)cm,including 38 cases≥5cm,46 cases<5cm;24 cases of hypertension with basic diseases,15 cases of coronary heart disease,21 cases of diabetes,24 cases of no basic disease,average body mass index(BMI)(25.24±3.34)Kg/m~2,of which 41 cases were≥24Kg/m~2,43 cases were<24Kg/m~2;the average distance between the anastomosis and anus was(4.26±1.85)cm,of which 37 cases were≥5cm and 47cases were<5cm The average length of the intestinal tube removed was(9.62±4.86)cm,of which 50 cases were≥10cm and 34 cases were less than 10cm;55 cases of tumor invasion were in T1-2 stage,29 cases were in T3-4 stage;60 cases had lymph node metastasis,There were 24 cases without lymph node metastasis;18 cases were classified as grade I,25 cases in grade II,41 cases in grade III;27 cases underwent neoadjuvant radiotherapy and chemotherapy before operation,and 57 cases underwent neoadjuvant radiotherapy and chemotherapy.All patients successfully completed the operation,The median operation time was 222(180-260)min,and the average(240.45±23.05)min;the median intraoperative blood loss was 165(125-300)ml,with an average of(173.24±59.62)ml,the median time of first exhaust after operation was 156(96-240)h,with an average of(157.68±31.68)h,8 patients had incision infection after operation,all of them were treated with wounds Washing,dressing,placement and drainage improved;4 patients developed venous thrombosis in the lower extremities,and improved after immobilization and thrombolysis;2 patients had incisions collapsed and were sutured for emergency surgery,7 patients had anastomotic leakage,4 patients were treated Conservative treatment,3 cases underwent secondary operation anastomotic suture,pelvic irrigation and drainage,ileostomy,and elective return.It is worth noting that all 7 patients with anastomotic leakage had more serious LARS.Univariate analysis showed that N staging,distance from anastomosis to anus,preoperative radiotherapy and chemotherapy,and postoperative anastomotic leakage were the influencing factors of LARS in patients after anal-preserving radical resection of rectal cancer(P<0.05).Logistic regression analysis showed that N staging,distance from anastomosis to anus,preoperative radiotherapy and chemotherapy,and postoperative anastomotic leakage are independent risk factors that affect the occurrence of LARS in patients with rectal cancer 6 months after anal-preserving radical resection(OR>1,P<0.05).Anastomosis Distance from the anus,preoperative radiotherapy and chemotherapy,and postoperative anastomotic leakage are independent risk factors that affect the occurrence of LARS in patients with rectal cancer 12 months after anal-preserving radical resection(OR>1,P<0.05),and are related to rectal cancer radical anal-preserving surgery Compared with the last6 months,the LARS score at 12 months after the operation showed a downward trend(P<0.05).Conclusions(1)N staging,preoperative radiotherapy and chemotherapy,distance from anastomosis to anus,postoperative anastomotic leakage are independent risk factors that affect the occurrence of LARS in patients after laparoscopic rectal cancer surgery.(2)With the passage of time,the symptoms of LARS in patients with rectal cancer after radical anus preserving surgery show some improvement.