Title : Risk Factors for low anterior resection syndrome in patients undergoing robotic-assisted surgery for low and middle rectal cancer
Abstract:
Background: Robotic-assisted surgery for rectal cancer has been demonstrated to be advantageous in terms of reduced intraoperative blood loss, lower conversion rates, and higher negative resection margin rate than traditional open surgery or laparoscopic surgery. Low anterior resection syndrome (LARS) is a common postoperative complication after anal-sparing surgery for rectal cancer. The present study aimed to explore the risk factors for LARS after robotic-surgery for low and middle rectal cancer.
Methods: In this single-center retrospective analysis, data from 197 patients undergoing surgical resection for low and middle rectal cancer were gathered. Patients were dichotomized into the LARS and non-LARS group based on whether LARS occurred within 18 months postoperatively. Data on patients’ demographics, treatment modalities, and intraoperative findings were collected and compared between the 2 groups. Binary logistic regression was applied to determine the independent risk factors for LARS.
Results: LARS occurred in 103 patients, accounting for 52.28% of all included patients. Compared with the non-LARS group, patients in the LARS group were associated with significantly older age (62.4±8.5 vs 68.5±9.2, P<0.001), higher tumor location in the low rectum (39/94 vs 62/103, P=0.009), higher neoadjuvant chemotherapy rate (8/94 vs 19/103, P=0.04), advanced tumor stage of T3 (32/94 vs 52/103, P=0.02), and higher rate of postoperative anastomotic leakage (2/94 vs 11/103, P=0.03). The multivariable-adjusted logistic regression showed that tumor location in the low rectum (HR=2.32, P<0.001), neoadjuvant chemotherapy (HR=1.42, P=0.02), and postoperative anastomotic leakage (HR=4.21, P<0.001) were independently associated with LARS.
Conclusions: Patients with low rectal caner, neoadjuvant chemotherapy and postoperative anastomotic leakage were significantly associated with postoperative LARS in those undergoing robotic-assisted surgery.
