부산대학교 도서관

Introduction The advance in diagnosis and treatment of rectal cancer has allowed an improvement in prognosis. The technological development and the progression in the training of specialized surgeons has resulted in an increase in the rate of sphincter-sparing surgery, and therefore in an increase in patients suffering from functional defecatory disorders after rectal cancer surgery. Aim and thesis Firstly, to assess the experience and perception of surgeons dedicated to the treatment of rectal cancer about their technical preferences as well as their etiopathogenic considerations in low anterior resection syndrome. Secondly, to analyze different factors potentially associated with development of low anterior resection syndrome. Mehod A survey was designed that covers several areas: the scope and experience of the surgeon, the technical preferences and aspects related to the low anterior resection syndrome. The results are described as descriptive statistics. On the other hand, a cross-sectional study was carried out in two third-level hospitals, in which patients who underwent rectal cancer with sphincter preservation between January 2001 and December 2009 were invited to fill in a validated defecatory function questionnaire ( "LARS score"). The variables under study were assessed by univariate and multivariate analyses. Results Sphincter preservation rate that surgeons estimate according to the survey is between 71 and 90%. The technique of choice is end-to-end anastomosis. Although there is awareness about low anterior resection syndrome, its severity is usually measured by clinical criteria without questionnaires. Almost 75% of surgeons interviewed believe that major low anterior resection syndrome does not affect more than 40% of patients. Likewise, they report that distance from anastomosis to anal margin is the most important risk factor. On the other hand, 56.2% of patients with low anterior resection suffer from "major" syndrome, 19.6% "minor" and 23.9% do not present the syndrome. In the multivariate analysis, total mesorectum excision and radiotherapy were independent risk factors for major low anterior resection syndrome. Conclusions Although there is awareness of low anterior resection syndrome, probability of suffering it and its severity is underestimated. The variable that shows the greatest strength of association with the severity of the anterior resection syndrome is radiotherapy, both preoperatively and postoperatively.