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Multicenter investigation of bowel evacuation function after transanal total mesorectal excision for mid-low rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

To determine the effect of transanal total mesorectal excision (taTME) procedure on the postoperative bowel evacuation function of patients with low rectal cancer.

Methods

Bowel evacuation function was investigated in 316 patients with rectal cancer after taTME in 18 hospitals in China. Low anterior resection syndrome (LARS) score, Wexner score, and EORTC QLQ-C30 were used for functional evaluation. The association between perioperative risk factors and LARS score was determined by univariate and multivariate analyses.

Results

The prevalence rate of no LARS, minor LARS, and major LARS in patients after taTME was 39.9%, 28.2%, and 31.9%, respectively. The two most frequently reported symptoms of LARS after taTME were bowel clustering (72.8%) and fecal urgency (63.3%). Patients with major LARS had significantly higher Wexner score and worse global health status and financial difficulties according to the EORTC QLQ-C30 questionnaire than those without major LARS. Preoperative chemoradiotherapy was an independent risk factor of major LARS occurrence after taTME (OR: 3.503, P = 0.044); existing preoperative constipation (OR: 0.082, P = 0.040) and manual anastomosis (OR: 4.536, P = 0.021) were favorable factors affecting bowel evacuatory function within 12 months after taTME, but for patients whose follow-up time was longer than 12 months, postoperative chemoradiotherapy (OR: 8.790, P = 0.001) and defunctioning stoma (OR: 3.962, P = 0.010) were independent risk factors.

Conclusions

The bowel evacuation function after taTME is acceptable. Perioperative chemoradiotherapy, anastomotic method, and preoperative constipation are factors associated with bowel dysfunction after taTME.

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Acknowledgments

We thank the International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China

    Zhanlong Shen, Chao Ding, Kewei Jiang, Shan Wang & Yingjiang Ye

  2. Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China

    Zhanlong Shen, Chao Ding, Kewei Jiang, Shan Wang & Yingjiang Ye

  3. Department of Colorectal Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266035, Shandong, People’s Republic of China

    Gang Yu

  4. Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, People’s Republic of China

    Mingyang Ren

  5. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China

    Hongyu Zhang

  6. Department of General Surgery, Zigong First People’s Hospital, Zigong, 643000, Sichuan, People’s Republic of China

    Shuhua Li

  7. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People’s Republic of China

    Qing Xu

  8. Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun, 130021, Jilin, People’s Republic of China

    Quan Wang

  9. Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, People’s Republic of China

    Yuanguang Chen

  10. Department of Colorectal-Anal Surgery, Third Hospital of Jilin University and Bethune Hospital, Changchun, 130033, Jilin, People’s Republic of China

    Zhongshi Xie

  11. Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, Liaoning, People’s Republic of China

    Qingtong Zhang

  12. Department of Gastrointestinal Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, People’s Republic of China

    Kai Ye

  13. Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, People’s Republic of China

    Xuedong Xu

  14. Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China

    Jianbin Xiang

  15. Department of Colorectal Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People’s Republic of China

    Hong Zhang

  16. Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, 810000, Qinghai, People’s Republic of China

    Su Yan

  17. Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China

    Canrong Lu

  18. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China

    Hongwei Yao

  19. Department of General Surgery, Dongguan Kanghua Hospital, 1000, Dongguan, Avenue, Guangdong, People’s Republic of China

    Hao Zhang

  20. Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, People’s Republic of China

    Liang Kang

Authors
  1. Zhanlong Shen
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  2. Gang Yu
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  5. Hongyu Zhang
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  6. Shuhua Li
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  7. Qing Xu
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  8. Quan Wang
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  9. Yuanguang Chen
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  11. Qingtong Zhang
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  12. Kai Ye
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  14. Jianbin Xiang
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  15. Hong Zhang
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  16. Su Yan
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  17. Canrong Lu
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  18. Hongwei Yao
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  19. Hao Zhang
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  20. Liang Kang
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  21. Kewei Jiang
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  22. Shan Wang
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  23. Yingjiang Ye
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Corresponding authors

Correspondence to Zhanlong Shen or Yingjiang Ye.

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Zhanlong Shen, Gang Yu, Mingyang Ren, and Chao Ding have equal first authorship.

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Shen, Z., Yu, G., Ren, M. et al. Multicenter investigation of bowel evacuation function after transanal total mesorectal excision for mid-low rectal cancer. Int J Colorectal Dis 36, 725–734 (2021). https://doi.org/10.1007/s00384-020-03824-3

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