Uni-center, patient-blinded, randomized, 12-month, parallel group, noninferiority study to compare outcomes of 3-row vs 2-row circular staplers for colorectal anastomosis formation after low anterior resection for rectal cancer

Effect of low anterior resection syndrome on quality of life in colorectal cancer patients: A retrospective observational study

BACKGROUND

Low anterior resection syndrome (LARS) is a common complication of anus-preserving surgery in patients with colorectal cancer, which significantly affects patients' quality of life.

AIM

To determine the relationship between the incidence of LARS and patient quality of life after colorectal cancer surgery and to establish a LARS prediction model to allow perioperative precision nursing.

METHODS

We reviewed the data from patients who underwent elective radical resection for colorectal cancer at our institution from April 2013 to June 2020 and completed the LARS score questionnaire and the European Organization for Research and Treatment of Cancer Core Quality of Life and Colorectal Cancer Module questionnaires. According to the LARS score results, the patients were divided into no LARS, mild LARS, and severe LARS groups. The incidence of LARS and the effects of this condition on patient quality of life were determined. Univariate and multivariate analyses were performed to identify independent risk factors for the occurrence of LARS. Based on these factors, we established a risk prediction model for LARS and evaluated its performance.

RESULTS

Among the 223 patients included, 51 did not develop LARS and 171 had mild or severe LARS. The following quality of life indicators showed significant differences between patients without LARS and those with mild or severe LARS: Physical, role, emotional, and cognitive function, total health status, fatigue, pain, shortness of breath, insomnia, constipation, and diarrhea. Tumor size, partial/total mesorectal excision, colostomy, preoperative radiotherapy, and neoadjuvant chemotherapy were identified to be independent risk factors for LARS. A LARS prediction model was successfully established, which demonstrated an accuracy of 0.808 for predicting the occurrence of LARS.

CONCLUSION

The quality of life of patients with LARS after colorectal cancer surgery is significantly reduced.

Risk factors of postoperative low anterior resection syndrome for colorectal cancer: A meta-analysis

The prevalence of postoperative low anterior resection syndrome (LARS) in patients with colorectal cancer is high, which seriously affects the quality of life after operation. The purpose of this meta-analysis is to systematically evaluate the related factors of LARS in patients with colorectal cancer and provide reference for clinicians when making reasoned decisions. A systematic electronic search of PubMed, Embase, The Cochrane Library, WANFANG and CNKI was performed from 2012 to Dec 2020. We analyzed the risk factors of LARS by extracting baseline data and clinical results. The odds ratio (OR) was used to analyze binary variables. A total of 5102 patients were included in 21 literatures, of which the prevalence of LARS was 49.7% (2538/5102). Meta-analysis showed that there was no significant difference in the influence of age (P = 0.48) and sex (P = 0.68) on LARS, but low tumor height (P < 0.001), low anastomotic height (P < 0.001), radiotherapy and chemotherapy (P < 0.001) and postoperative anastomotic leakage (P < 0.001), disfunction stoma (P < 0.001) are high risk factors for the prevalence of LARS. Low tumor height, low anastomotic height, radiotherapy and chemotherapy, anastomotic leakage and disfunction stoma are risk factors for postoperative LARS in patients with colorectal cancer. Clinicians should pay attention to these indicators of patients to provide better clinical intervention for patients and improve their quality of life after operation.

Comparative analysis of modified Bacon operation and double stapler operation in the treatment of rectal cancer

OBJECTIVE

To investigate the efficacy of modified Bacon operation and double stapler operation in treating lower rectal cancer.

METHODS

A total of 73 patients with lower rectal cancer admitted to the general surgery department of our hospital from March 2016 to March 2017 were selected for the study. According to different operation methods, the patients were divided into an observation group and a control group. Modified Bacon operation was used in the observation group (39 cases), while double stapler operation was adopted for the control group (34 cases). The intraoperative and postoperative conditions and 3-year survival rates were observed.

RESULTS

The bleeding volume and anal exhaust time in the observation group were better than those in the control group, the difference being statistically significant (P<0.05). No significant difference was found between the two groups in terms of the operation time, abdominal drainage volume, anal extubation time, or the number of lymph node dissection (P>0.05). The anal function of the two groups was evaluated one month and six months after operation respectively, and no significant difference was found between the function of the two groups (P>0.05). There was no significant difference in postoperative complications, local recurrence, and distant metastasis between the two groups (P>0.05). The 3-year survival rate was 89.74% in the observation group and 91.18% in the control group. Our analysis found no significant difference in the cumulative survival rates between the two groups (P>0.05).

CONCLUSION

Modified Bacon operation and double stapler operation are effective treatment for lower rectal cancer, and the survival benefit of patients is obvious. The methods are worthy of clinical promotion.