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The impact of the anastomotic configuration on low anterior resection syndrome 3 years after total mesorectal excision for rectal cancer : a national cohort study

Sandberg, Sofia ; Bock, David ; Lydrup, Marie Louise LU ; Park, Jennifer ; Rutegård, Martin and Angenete, Eva (2023) In Colorectal Disease 25(6). p.1144-1152
Abstract

Aim: After low anterior resection, the bowel can be anastomosed in different ways. It is not clear which configuration is optimal from a functional and complication point of view. The primary aim was to investigate the impact of the anastomotic configuration on bowel function evaluated by the low anterior resection syndrome (LARS) score. Secondarily, the impact on postoperative complications was evaluated. Method: All patients who had undergone low anterior resection from 2015 to 2017 were identified in the Swedish Colorectal Cancer Registry. Three years after surgery, patients were sent an extensive questionnaire and were analysed based on anastomotic configuration (‘J-pouch/side-to-end anastomosis’ or ‘straight anastomosis’). Inverse... (More)

Aim: After low anterior resection, the bowel can be anastomosed in different ways. It is not clear which configuration is optimal from a functional and complication point of view. The primary aim was to investigate the impact of the anastomotic configuration on bowel function evaluated by the low anterior resection syndrome (LARS) score. Secondarily, the impact on postoperative complications was evaluated. Method: All patients who had undergone low anterior resection from 2015 to 2017 were identified in the Swedish Colorectal Cancer Registry. Three years after surgery, patients were sent an extensive questionnaire and were analysed based on anastomotic configuration (‘J-pouch/side-to-end anastomosis’ or ‘straight anastomosis’). Inverse probability weighting by propensity score was used to adjust for confounding factors. Results: Among 892 patients, 574 (64%) responded, of whom 494 patients were analysed. After weighting, the anastomotic configuration had no significant impact on the LARS score (J-pouch/side-to-end OR 1.05, 95% confidence interval [CI] 0.82–1.34). The J-pouch/side-to-end anastomosis was significantly associated with overall postoperative complications (OR 1.43, 95% CI 1.06–1.95). No significant difference was seen regarding surgical complications (OR 1.14, 95% CI 0.78–1.66). Conclusion: This is the first study investigating the impact of the anastomotic configuration on long-term bowel function, evaluated by the LARS score, in an unselected national cohort. Our results suggested no benefit for J-pouch/side-to-end anastomosis on long-term bowel function and postoperative complication rates. The anastomotic strategy may be based upon the anatomical conditions of the patient and surgical preference.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
colorectal cancer, functional, low anterior resection, low anterior resection syndrome, surgical technique
in
Colorectal Disease
volume
25
issue
6
pages
1144 - 1152
publisher
Wiley-Blackwell
external identifiers
  • scopus:85150617639
  • pmid:36794476
ISSN
1462-8910
DOI
10.1111/codi.16523
language
English
LU publication?
yes
id
c5c27bb0-7dbe-4ba3-b154-9660c08ab2bc
date added to LUP
2023-05-29 14:10:18
date last changed
2024-07-13 05:54:12
@article{c5c27bb0-7dbe-4ba3-b154-9660c08ab2bc,
  abstract     = {{<p>Aim: After low anterior resection, the bowel can be anastomosed in different ways. It is not clear which configuration is optimal from a functional and complication point of view. The primary aim was to investigate the impact of the anastomotic configuration on bowel function evaluated by the low anterior resection syndrome (LARS) score. Secondarily, the impact on postoperative complications was evaluated. Method: All patients who had undergone low anterior resection from 2015 to 2017 were identified in the Swedish Colorectal Cancer Registry. Three years after surgery, patients were sent an extensive questionnaire and were analysed based on anastomotic configuration (‘J-pouch/side-to-end anastomosis’ or ‘straight anastomosis’). Inverse probability weighting by propensity score was used to adjust for confounding factors. Results: Among 892 patients, 574 (64%) responded, of whom 494 patients were analysed. After weighting, the anastomotic configuration had no significant impact on the LARS score (J-pouch/side-to-end OR 1.05, 95% confidence interval [CI] 0.82–1.34). The J-pouch/side-to-end anastomosis was significantly associated with overall postoperative complications (OR 1.43, 95% CI 1.06–1.95). No significant difference was seen regarding surgical complications (OR 1.14, 95% CI 0.78–1.66). Conclusion: This is the first study investigating the impact of the anastomotic configuration on long-term bowel function, evaluated by the LARS score, in an unselected national cohort. Our results suggested no benefit for J-pouch/side-to-end anastomosis on long-term bowel function and postoperative complication rates. The anastomotic strategy may be based upon the anatomical conditions of the patient and surgical preference.</p>}},
  author       = {{Sandberg, Sofia and Bock, David and Lydrup, Marie Louise and Park, Jennifer and Rutegård, Martin and Angenete, Eva}},
  issn         = {{1462-8910}},
  keywords     = {{colorectal cancer; functional; low anterior resection; low anterior resection syndrome; surgical technique}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1144--1152}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Colorectal Disease}},
  title        = {{The impact of the anastomotic configuration on low anterior resection syndrome 3 years after total mesorectal excision for rectal cancer : a national cohort study}},
  url          = {{http://dx.doi.org/10.1111/codi.16523}},
  doi          = {{10.1111/codi.16523}},
  volume       = {{25}},
  year         = {{2023}},
}