Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome

Michał M Nowakowski; Mateusz Rubinkiewicz; Natalia Gajewska; Grzegorz Torbicz; Michał Wysocki; Piotr Małczak; Piotr Major; Mateusz Wierdak; Andrzej Budzyński; Michał Pędziwiatr

doi:10.5114/wiitm.2018.76913

Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome

Wideochir Inne Tech Maloinwazyjne. 2018 Sep;13(3):306-314. doi: 10.5114/wiitm.2018.76913. Epub 2018 Jul 3.

Authors

Michał M Nowakowski¹, Mateusz Rubinkiewicz², Natalia Gajewska², Grzegorz Torbicz², Michał Wysocki^{2

3}, Piotr Małczak^{2

3}, Piotr Major^{2

3}, Mateusz Wierdak^{2

3}, Andrzej Budzyński^{2

3}, Michał Pędziwiatr^{2

3}

Affiliations

¹ Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
² 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
³ Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.

Abstract

Introduction: Laparoscopic surgery is an approved technique in colorectal cancer treatment. Functional and quality-of-life studies have revealed significant changes in faecal continence.

Aim: To assess the incidence and risk factors of low anterior resection syndrome (LARS) in patients undergoing rectal resections for cancer.

Material and methods: We enrolled patients undergoing rectal resections in a general surgery department of a university hospital. The primary outcomes were the Jorge-Wexner scale and the LARS score 6 months after the end of treatment. The secondary outcomes were the risk factors for LARS development.

Results: Fifty-six patients were included; 15 (26%) developed major LARS and 10 (18%) had minor LARS at 6 months. In univariate analysis the risk factors were: preoperative radiotherapy (p < 0.001, OR = 11.9, 95% CI: 2.98-47.48); shorter distance of the tumour from the anal verge (p = 0.001, OR = 0.69, 95% CI: 0.55-0.86); bowel preparation (p = 0.01, OR = 6.27, 95% CI: 1.51-26.07); low anterior rectal resection (p = 0.01, OR = 17.07, 95% CI: 1.86-156.83); and protective ileostomy (p = 0.001, OR = 15.97, 95% CI: 4.07-61.92). The risk factors for a higher Jorge-Wexner score in univariate analysis were greater diameter of tumour (p = 0.035), radiotherapy (p = 0.001), shorter distance from the anal verge (p = 0.002), bowel preparation (p = 0.042), low anterior rectal (LAR) (p = 0.01), ileostomy (p = 0.001), perioperative complications (p = 0.032), and readmission within 30 days (p = 0.034). In the multivariate analysis, readmissions and perioperative complications were significant.

Conclusions: In addition to typically described risk factors, two new ones have been identified. Mechanical bowel preparation and defunctioning ileostomy may also contribute to LARS development. However, due to the limitations of this study our observations require further confirmation in future trials.

Keywords: ileostomy; low anterior resection; low anterior resection syndrome; mechanical bowel preparation; rectal cancer; risk factors.