Objective: This study aims to explore the temporal trend of Low Anterior Resection Syndrome (LARS) and its symptoms after laparoscopic anterior resection for rectal cancer. Methods: A retrospective cohort study design was employed. The study included primary rectal (adenocarcinoma) cancer patients who underwent laparoscopic anterior resection at Tongji Hospital, Huazhong University of Science and Technology, between January 1, 2010, and December 31, 2020. Complete medical records and follow-up data at 3, 6, 9, 12, and 18 months postoperatively were available for all patients. A total of 1454 patients were included, of whom 1094 (75.2%) were aged ≤65 years, and 597 (41.1%) were females. Among them, 1040 cases (71.5%) had an anastomosis-to-anus distance of 0-5cm, and 86 cases (5.9%) received neoadjuvant treatment. All patients completed the Chinese version of the LARS questionnaire and their LARS occurrence and specific symptom information were recorded at 3, 6, 9, 12, and 18 months postoperatively. Considering past literature and clinical experience, further subgroup analyses were performed to explore the potential impact factors on severe LARS, including anastomosis level, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and the presence of preventive stoma. Results: The occurrence rates of LARS at 3, 6, 9, 12, and 18 months postoperatively were 78.5% (1142/1454), 71.4% (1038/1454), 55.0% (799/1454), 45.7% (664/1454), and 45.7% (664/1454), respectively (χ2=546.180, P<0.001). No statistically significant difference was observed between the 12-month and 18-month time points (P>0.05). When compared with the symptoms at 3 months, the occurrence rates of gas incontinence [1.7% (24/1454) vs. 33.9% (493/1454)], liquid stool incontinence [3.9% (56/1454) vs. 41.9% (609/1454)], increased stool frequency [79.6% (1158/1454) vs. 95.9% (1395/1454)], stool clustering [74.3% (1081/1454) vs. 92.9% (1351/1454)], and stool urgency [46.5% (676/1454) vs. 78.7% (1144/1454)] in the LARS symptom spectrum were significantly alleviated at 12 months (all P<0.05) and remained stable beyond 12 months (all P>0.05). With the extension of postoperative time, the incidence rates of severe LARS exhibited a decreasing trend in different subgroups, of anastomosis level, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and the presence of preventive stoma, and reached stability at 12 months postoperatively (all P>0.05). Conclusion: LARS and its specific symptom profile showed a trend of gradual improvement over time up to 1 year postoperatively, and stabilized after more than 1 year. Increased stool frequency and stool clustering are the most common features of abnormal bowel dys function, which improve slowly after surgery.
目的： 探究腹腔镜直肠癌前切除术后低位前切除综合征（LARS）及其症状随时间变化的趋势。 方法： 本研究采用回顾性队列研究的方法。回顾性纳入2010年1月1日至2020年12月31日期间，在华中科技大学同济医学院附属同济医院接受腹腔镜直肠癌前切除的原发性直肠（腺）癌患者，所有患者病历资料完整，术后3、6、9、12和18个月时间点的随访资料齐全。共1 454例患者纳入本研究，年龄≤65岁1 094例（75.2%），女性597例（41.1%）。吻合口距肛缘的距离为0~5 cm者1 040例（71.5%），新辅助治疗患者86例（5.9%）。所有患者均完成汉化版LARS评分问卷表并记录术后3、6、9、12和18个月时LARS的发生率及其具体症状的情况，并综合既往文献报道和临床经验，对吻合口位置、术前新辅助治疗、术后辅助治疗、有无预防性造口等可能影响重度LARS的相关亚组行进一步分析。 结果： 1 454例患者术后3、6、9、12和18个月时，LARS的发生率分别为78.5%（1 142/1 454）、71.4%（1 038/1 454）、55.0%（799/1 454）、45.7%（664/1 454）和45.7%（664/1 454），整体差异有统计学意义（χ2=546.180，P<0.001），但12个月后趋于稳定（P>0.05）。与术后3个月相比，术后12个月时LARS的症状谱中排气失禁［1.7%（24/1 454）比33.9%（493/1 454）］，液体大便失禁［3.9%（56/1 454）比41.9%（609/1 454）］，大便频率增加［79.6%（1 158/1 454）比95.9%（1 395/1 454）］，大便簇集［74.4%（1 081/1 454）比92.9%（1 351/1 454）］，排便急迫［46.5%（676/1 454）比78.7%（1 144/1 454）］的发生率均有缓解（均P<0.05），而12个月以后稳定（均P>0.05）。随着术后时间的延长，重度LARS发生率在不同吻合口位置、术前新辅助治疗、术后辅助治疗、有无预防性造口等亚组中均呈下降趋势（均P<0.001），并在术后12个月时达到稳定（均P>0.05）。 结论： 术后1年内，LARS及其具体症状情况随时间增长呈逐渐改善趋势，但超过1年后趋于稳定。大便频率增加和簇集是最主要的肠道功能异常表现，术后改善缓慢。.