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Analysis of presacral tissue structure in LARS and the prevention of LARS by reconstruction of presacral mesorectum with pedicled greater omentum flap graft

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Abstract

Background

The greater omentum has played a unique biological role in regenerative surgery. The aim of our study was to alter the anterior sacral structure by filling the anterior sacral space with the greater omentum and evaluate its effect on the low anterior resection syndrome (LARS) after total mesorectal excision (TME) surgery for low rectal cancer.

Methods

We retrospectively collected clinical data of patients with primary low rectal cancer who underwent TME and ileostomy closure in our hospital from March 2018 to March 2020. Spearman correlation analysis was conducted to analyze the correlation between postoperative mesorectal fascia (MRF) thickness and LARS score. Subsequently, we prospectively used a tipped greater omental flap graft to reconstruct the anterior rectal sacral structures (MRF reconstruction) in 17 patients and compared LARS scores and rectal compliance (RC) at week 12 after closure of the ileostomy in both groups.

Results

There were 47 patients with No-MRF reconstruction (31 males, mean age 60.68 ± 9.21 years) and 17 with MRF reconstruction (10 males, mean age 49.82 ± 14.74 years). Correlation analysis indicated that MRF thickness and RC were negatively correlated with LARS severity (p < 0.05). The LARS score of patients with MRF reconstruction at 12 weeks was significantly better than that of those with No-MRF reconstruction (32.97 ± 2.65 vs. 26.94 ± 1.52, p = 0.001), and the RC of MRF reconstruction were lower (2.80 ± 0.55 vs. 3.67 ± 0.38, p = 0.001). In addition, MRF reconstruction and No-MRF reconstruction have the similar incidence of postoperative complications (p = 0.156). No hemorrhage or necrosis of the greater omentum flap was observed in any of the patients.

Conclusions

Greater omentum flap transplantation can significantly improve the symptoms of LARS at 12 weeks after ileostomy closure and we expect it to become a new surgical procedure for the treatment of low rectal cancer.

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References:

  1. Jin G (2006) Surgical surgery for low rectal cancer. J Oncol 01:27–30

    Google Scholar 

  2. Tytherleigh MG, Mc CMNJ (2003) Options for sphincter preservation in surgery for low rectal cancer. Br J Surg 90(8):922–933. https://doi.org/10.1002/bjs.4296

    Article  CAS  PubMed  Google Scholar 

  3. Ghareeb WM, Wang X, Chi P, Wang W (2020) The “multilayer” theory of Denonvilliers’ fascia: anatomical dissection of cadavers with the aim to improve neurovascular bundle preservation during rectal mobilization. Colorectal Dis 22(2):195–202. https://doi.org/10.1111/codi.14850

    Article  CAS  PubMed  Google Scholar 

  4. Nguyen TH, Chokshi RV (2020) Low anterior resection syndrome. Curr Gastroenterol Rep 22(10):48. https://doi.org/10.1007/s11894-020-00785-z

    Article  PubMed  PubMed Central  Google Scholar 

  5. Croese AD, Zubair ON, Lonie J, Trollope AF, Vangaveti VN, Mushaya C, Ho YH (2018) Prevalence of low anterior resection syndrome at a regional Australian centre. ANZ J Surg 88(12):E813-e817. https://doi.org/10.1111/ans.14749

    Article  PubMed  Google Scholar 

  6. Lembo T, Munakata J, Mertz H, Niazi N, Kodner A, Nikas V, Mayer EA (1994) Evidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome. Gastroenterology 107(6):1686–1696. https://doi.org/10.1016/0016-5085(94)90809-5

    Article  CAS  PubMed  Google Scholar 

  7. Di Nicola V (2019) Omentum a powerful biological source in regenerative surgery. Regen Therapy 11:182–191. https://doi.org/10.1016/j.reth.2019.07.008

    Article  Google Scholar 

  8. Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255(5):922–928. https://doi.org/10.1097/SLA.0b013e31824f1c21

    Article  PubMed  Google Scholar 

  9. Hou XT, Pang D, Lu Q, Yang P, Jin SL, Zhou YJ, Tian SH (2015) Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients. Eur J Oncol Nurs 19(5):495–501. https://doi.org/10.1016/j.ejon.2015.02.009

    Article  PubMed  Google Scholar 

  10. Felt-Bersma RJ, Sloots CE, Poen AC, Cuesta MA, Meuwissen SG (2000) Rectal compliance as a routine measurement: extreme volumes have direct clinical impact and normal volumes exclude rectum as a problem. Dis Colon Rectum 43(12):1732–1738. https://doi.org/10.1007/bf02236859

    Article  CAS  PubMed  Google Scholar 

  11. Silen W (1993) Mesorectal excision for rectal cancer. Lancet (London, England) 341(8855):1279–1280. https://doi.org/10.1016/0140-6736(93)91182-l

    Article  CAS  Google Scholar 

  12. Tuson JR, Everett WG (1990) A retrospective study of colostomies, leaks and strictures after colorectal anastomosis. Int J Colorectal Dis 5(1):44–48. https://doi.org/10.1007/bf00496150

    Article  CAS  PubMed  Google Scholar 

  13. Pucciani F (2013) A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updat Surg 65(4):257–263. https://doi.org/10.1007/s13304-013-0220-5

    Article  Google Scholar 

  14. Lee SJ, Park YS (1998) Serial evaluation of anorectal function following low anterior resection of the rectum. Int J Colorectal Dis 13(5–6):241–246. https://doi.org/10.1007/s003840050169

    Article  CAS  PubMed  Google Scholar 

  15. Nesbakken A, Nygaard K, Lunde OC (2002) Mesorectal excision for rectal cancer: functional outcome after low anterior resection and colorectal anastomosis without a reservoir. Colorectal Dis 4(3):172–176. https://doi.org/10.1046/j.1463-1318.2002.00305.x

    Article  CAS  PubMed  Google Scholar 

  16. Ulrich A, Z’Graggen K, Weitz J, Büchler MW (2005) Functional results of the colon J-pouch versus transverse coloplasty pouch in Heidelberg. Recent Results Cancer Res Fortschritte Krebsforschung Progr Dans Rech Sur Cancer 165:205–211. https://doi.org/10.1007/3-540-27449-9_22

    Article  Google Scholar 

  17. Rink AD, Sgourakis G, Sotiropoulos GC, Lang H, Vestweber KH (2009) The colon J-pouch as a cause of evacuation disorders after rectal resection: myth or fact? Langenbecks Arch Surg 394(1):79–91. https://doi.org/10.1007/s00423-008-0364-9

    Article  PubMed  Google Scholar 

  18. Suzuki H, Matsumoto K, Amano S, Fujioka M, Honzumi M (1980) Anorectal pressure and rectal compliance after low anterior resection. Br J Surg 67(9):655–657. https://doi.org/10.1002/bjs.1800670917

    Article  CAS  PubMed  Google Scholar 

  19. Dal Lago A, Minetti AE, Biondetti P, Corsetti M, Basilisco G (2005) Magnetic resonance imaging of the rectum during distension. Dis Colon Rectum 48(6):1220–1227. https://doi.org/10.1007/s10350-004-0933-0

    Article  Google Scholar 

  20. Morihiro M, Koda K, Seike K, Miyauchi H, Miyazaki M (2008) Characteristic findings on defecography according to reconstruction method and defecatory disorder following sphincter-saving surgery for rectal cancer. Int J Colorectal Dis 23(9):883–892. https://doi.org/10.1007/s00384-008-0485-1

    Article  PubMed  Google Scholar 

  21. Iizuka I, Koda K, Seike K, Shimizu K, Takami Y, Fukuda H, Tsuchida D, Oda K, Takiguchi N, Miyazaki M (2004) Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer. Am J Surg 188(2):176–180. https://doi.org/10.1016/j.amjsurg.2003.12.064

    Article  PubMed  Google Scholar 

  22. Madoff RD, Orrom WJ, Rothenberger DA, Goldberg SM (1990) Rectal compliance: a critical reappraisal. Int J Colorectal Dis 5(1):37–40. https://doi.org/10.1007/bf00496148

    Article  CAS  PubMed  Google Scholar 

  23. Goldsmith HS, Chen WF, Duckett SW (1973) Brain vascularization by intact omentum. Arch Surg 106(5):695–698. https://doi.org/10.1001/archsurg.1973.01350170061015

    Article  CAS  PubMed  Google Scholar 

  24. Bikfalvi A, Alterio J, Inyang AL, Dupuy E, Laurent M, Hartmann MP, Vigny L, Raulais D, Courtois Y, Tobelem G (1990) Basic fibroblast growth factor expression in human omental microvascular endothelial cells and the effect of phorbol ester. J Cell Physiol 144(1):151–158. https://doi.org/10.1002/jcp.1041440120

    Article  CAS  PubMed  Google Scholar 

  25. Shafik A (1991) Idiopathic oligofecorrhea: a clinicopathologic entity–pathogenesis and treatment. Digestion 48(1):51–58. https://doi.org/10.1159/000200663

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was funded by the Self-Financing Research Project of the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region (Z2015607); the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (S2017098); 2019 Guangxi University High-level Innovation Team and the Project of Outstanding Scholars Program, and Guangxi Science and Technology Project (2019AC03004); Guangxi Science and Technology Base and Talent Project (AD19245197).

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Author notes

  1. Linghou Meng and Haiquan Qin contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning, 530021, Guangxi Zhuang Autonomous Region, People’s Republic of China

    Linghou Meng, Haiquan Qin, Zigao Huang, Jiankun Liao, Jinghua Cai, Yan Feng, Shanshan Luo, Hao Lai, Weizhong Tang & Xianwei Mo

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  1. Linghou Meng
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Contributions

All authors contributed to the study conception and design. First, LM, HQ and XM conceived the study. Second, ZH, JL, SL and HL contributed to data acquisition and analysis. LM, ZH, HQ and YF interpreted data and drafted the manuscript. Finally, XM and WT revised the manuscript and proved the final version. In addition, all of the authors revised and approved the manuscript.

Corresponding authors

Correspondence to Weizhong Tang or Xianwei Mo.

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Conflict of interest

The authors declare that we have no conflict of interest.

Availability of data and materials

The data used and/or analyzed in this study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The ethics review committee of Guangxi Medical University Cancer Hospital approved the present study (No. CS2021(14)).

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Written informed consent for this research was obtained from the patient prior to surgery. The patient has provided written permission for the publication.

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Meng, L., Qin, H., Huang, Z. et al. Analysis of presacral tissue structure in LARS and the prevention of LARS by reconstruction of presacral mesorectum with pedicled greater omentum flap graft. Tech Coloproctol 25, 1291–1300 (2021). https://doi.org/10.1007/s10151-021-02521-9

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