直肠癌低位前切除术中是否保留左结肠动脉与术后低位前切除综合征发生关系的研究

Objective To investigate the correlation between whether the left colonic artery(LCA) is preserved intraoperatively and the incidence of severe low anterior resection syndrome(LARS) in patients with rectal cancer. Methods Clinical data of 255 rectal cancer patients undergoing low anterior resection from Jan 2020 to Jan 2022 at the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analysed, and the occurrence of LARS in patients with or without preserving the LCA was compared. Results The LARS scores and severity in patients with intact LCA were better than those without preserved LCA at 12 months postoperatively (P=0.017, 0.002). Bowel function at 6 months versus 12 months postoperatively in both groups was mainly reflected in a reduction in the number of bowel movements per day (P=0.003, 0.001) as well as a reduction in re-voiding of the bowel within 1 hour after defecation (P<0.001, P=0.001). Univariate and multivariate analyses showed that the distance of the lower edge of the tumour from the anal verge was ≤6 cm (OR=2.530, 95%CI:1.307-4.900, P=0.006), preoperative neoadjuvant therapy (OR=13.968, 95%CI: 4.969-39.260, P<0.001), prophylactic stoma (OR=4.051, 95%CI: 2.042-8.040,P<0.001) were also independent risk factors for severe LARS after anterior resection of rectal cancer, and preservation of the left colonic artery (OR=0.283, 95%CI: 0.142-0.563, P<0.001) was a protective factor against severe LARS after low anterior resection in rectal cancer patients. Conclusions Intraoperative preservation of the LCA reduces the incidence and severity of postoperative LARS in patients with rectal cancer undergoing anterior resection. The distance of the lower edge of thetumour from the anal verge and prophylactic stoma are independent risk factors affecting the occurrence of severe LARS after anterior resection of rectal cancer.