To explore the pathogenesis of anterior resection syndrome by magnetic resonance imaging rectal defecography

World J Gastrointest Surg. 2024 Feb 27;16(2):529-538. doi: 10.4240/wjgs.v16.i2.529.

Abstract

Background: Over 90% of rectal cancer patients develop low anterior resection syndrome (LARS) after sphincter-preserving resection. The current globally recognized evaluation method has many drawbacks and its subjectivity is too strong, which hinders the research and treatment of LARS.

Aim: To evaluate the anorectal function after colorectal cancer surgery by quantifying the index of magnetic resonance imaging (MRI) defecography, and pathogenesis of LARS.

Methods: We evaluated 34 patients using the standard LARS score, and a new LARS evaluation index was established using the dynamic images of MRI defecography to verify the LARS score.

Results: In the LARS score model, there were 10 (29.41%) mild and 24 (70.58%) severe cases of LARS. The comparison of defecation rate between the two groups was 29.36 ± 14.17% versus 46.83 ± 18.62% (P = 0.004); and MRI-rectal compliance (MRI-RC) score was 3.63 ± 1.96 versus 7.0 ± 3.21 (P = 0.001). Severe and mild LARS had significant differences using the two evaluation methods. There was a significant negative correlation between LARS and MRI-RC score (P < 0.001), and they had a negative correlation with defecation rate (P = 0.028).

Conclusion: MRI defecography and standard LARS score can both be used as an evaluation index to study the pathogenesis of LARS.

Keywords: Anterior resection syndrome; Colorectal cancer; Diagnostic evaluation system; Magnetic resonance imaging defecography; Pathogenesis.