Among 480 patients, those with a defunctioning stoma showed a positive correlation with (LARS) occurrence at 3, 6, and 12 months postoperatively (P < 0.001).
The occurrence of LARS was positively correlated with having a defunctioning stoma at multiple time points.
High body mass index (BMI), tumor proximity to the dentate line, and ultra-low anterior resection may increase the likelihood of developing LARS at 3 months.
High BMI and ultra-low anterior resection were not independent risk factors for LARS at 6 months postoperatively.
Proximity of the tumor to the dentate line was associated with an increased likelihood of LARS at 12 months.
Simplified
BACKGROUND: To evaluate the effect of stoma-related factors (stoma or no stoma, stoma type, and stoma reversal time) on the occurrence of (LARS), a highly prevalent condition that can develop after anal sphincter-sparing surgery for rectal cancer and impair quality of life, which includes fecal incontinence, fecal urgency and frequent defecation.
METHODS: Patients who underwent radical rectal cancer surgery from July 2018 to July 2022 in a tertiary hospital were included. Baseline data, tumor condition, operation condition and postoperative recovery were obtained by clinical observation. Follow-up data were collected by telephone follow-up. The chi-square and Fisher exact tests were used to analyse differences, coefficient of contingency was used to determine correlations, and independent risk factors for the occurrence of LARS (Patients with a score of 21 or more points were defined as having LARS using the LARS score) were further determined by binary logistic regression.
RESULTS: A total of 480 patients met the inclusion criteria, of which 267 used a defunctioning stoma and 213 did not use a defunctioning stoma. There was a positive correlation between defunctioning stoma (P < 0.001, P < 0.001, P < 0.05) and the occurrence of LARS at 3, 6, and 12 months postoperatively, and there was no significant correlation between the stoma type or stoma reversal time and the occurrence of LARS at 3, 6 and 12 months postoperatively (P > 0.05). In binary logistic regression analysis, high BMI (Exp(B) = 1.072, P = 0.039), tumor closer to dentate line (Exp(B) = 0.910, P = 0.016), and ultra-low anterior resection (Exp(B) = 2.264, P = 0.011) increased the possibility of LARS at 3 months postoperatively; high BMI, proximity of the tumor to the dentate line, and ultra-low anterior resection were not independent risk factors for LARS at 6 months postoperatively (P > 0.05). However, proximity of the tumor to the dentate line (Exp(B) = 0.880, P = 0.035) increased the likelihood of LARS at 12 months postoperatively, while high BMI and ultra-low anterior resection remained non-significant as independent risk factors for LARS at 12 months postoperatively (P > 0.05).
CONCLUSIONS: Defunctioning stoma was not an independent risk factor for the occurrence of LARS, whereas high BMI, tumor closer to dentate line, and ultra-low anterior resection were independent risk factors for the occurrence of LARS.
TRIAL REGISTRATION: Not applicable.
Key numbers
50.9%
Higher Incidence
Percentage of patients with in the defunctioning stoma group at 3 months post-surgery.
1.072×
BMI Risk Increase
Odds ratio indicating the effect of BMI on occurrence.
2.264×
Ultra-low Anterior Resection Risk Increase
Odds ratio comparing ultra-low anterior resection to intersphincteric resection.
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