Analysis Of Quality Of Life Of Patients After Anterior Resection Of Rectal Cancer

Objective To analyze the incidence and influencing factors of low anterior resection syndrome(LARS)after rectal cancer surgery and build a nomogram model.To investigate the effect of LARS on the quality of life of patients with rectal cancer after surgery,and to provide a theoretical basis for the prevention and treatment of LARS.Methods The research subjects were selected from August 2019 to December 2020 in the Department of Gastrointestinal Surgery,Inner Mongolia Medical University Affiliated Hospital,who underwent low anterior resection(Dixon)for rectal cancer.The operation followed the principle of TME,and the postoperative pathological diagnosis was rectal cancer.The patient’s medical records are kept intact,and the patient is informed and agrees to fill in the questionnaire.Outpatient follow-up or telephone follow-up was conducted at 3,6,and 12 months after operation,and the LARS,Wexner,I-PSS,FSFI,IIEF-5,QLQ-CR38 scales were improved,and medical records were reviewed in the medical record room.According to the patient LARS scale,the patients were divided into no LARS group,mild LARS group and severe LARS group.First,the incidence of LARS after rectal cancer surgery in our hospital was calculated.Secondly,the clinical factors of patients with and without LARS at 3,6,and 12 months after rectal cancer surgery were compared,the risk factors of LARS were analyzed,and a nomogram model was constructed and evaluated.Finally,the effect of LARS on the quality of life,defecation,urination and sexual function of patients after rectal cancer surgery,as well as the change of quality of life with recovery time in patients after rectal cancer surgery were discussed.Results A total of 228 patients were included in this study.The incidence of LARS in patients after anterior resection of rectal cancer was very high.At 3,6,and 12 months,133(58.3%),90(39.5%),and 44(19.3%)patients had LARS.In the univariate analysis of 3,6,and 12 months after rectal cancer surgery,BMI,neoadjuvant therapy,anastomotic leakage,tumor location,and the distance between anastomotic stoma and anal verge were statistically significant(P<0.05).Substituting into multivariate logistic regression analysis,BMI,neoadjuvant therapy,tumor location,and the distance between anastomotic stoma and anal verge were independent risk factors for LARS(P<0.05).A nomogram model was constructed for risk factors,and the Hosmer-Lemeshow test and ROC curve showed that the model had a good prediction effect.At 6 months after rectal cancer surgery,all functional dimensions(body image,sexual function,sexual satisfaction,future expectations)and symptom dimensions(gastrointestinal symptoms,adverse reactions of chemotherapy,defecation problems)on the QLQ-CR38 scale were Statistical significance(P<0.05),Wexner incontinence score was statistically significant(P<0.05).At 12 months after surgery,all functional dimensions(body image,sexual function,sexual satisfaction,future expectations)and symptom dimensions(defecation problems)in the QLQ-CR38 scale were statistically significant(P<0.05),Wexner incontinence,Wexner constipation score was statistically significant(P<0.05).Compared with patients 6 months after operation,all functional dimensions(body image,sexual function,sexual satisfaction,future expectation),symptom dimensions(urinary tract symptoms,gastrointestinal symptoms,adverse reactions of chemotherapy,defecation problems),Wexner incontinence,Wexner constipation and I-PSS were statistically significant in 12 months after operation(P < 0.05).Conclusion1)LARS is a common complication after anterior resection of rectal cancer,and the incidence of LARS decreases with prolonged postoperative recovery time.2)BMI,neoadjuvant therapy,tumor location,and anastomotic distance from the anal verge were independent risk factors for LARS after rectal cancer surgery.3)According to the results of multivariate analysis,a risk prediction model for LARS after rectal cancer surgery was constructed to provide a theoretical basis for clinicians to screen patients with high risk of LARS after rectal cancer surgery.4)LARS affects the quality of life and defecation function of patients after rectal cancer surgery.The quality of life,defecation function,and urination function of patients after rectal cancer surgery are improved over time.