Effect of different types of ISR combined with noadjuvant therapy on postoperative fecal function in patients with low rectal cancer / 中国医师进修杂志

ABSTRACT

Objective Although intersphinctoric resection is the standard method for clinical treatment of local low rectal cancer, it is lack of control for the occurrence and development of postoperative incontinence symptoms. Therefore, the effects of different ISR on postoperative stool function were analyzed retrospectively to provide guidance for judging the degree of fecal incontinence. Methods A total of 73 cases of ISR patients with low rectal adenocarcinoma treated in the oncology ward, and the outpatient department of our department from January 2014 to November 2017 were retrospectively studied. According to the distance of the tumor from the anal margin and different ISR procedures, 73 cases were divided into three groupgroup ISR (37 cases), subtotal ISR group (28 cases) and complete ISR group (8 cases). The anus dynamic index, Wexner subjective score of incontinence and multiple regression analysis were used to compare the severity of fecal incontinence in each group before and after operation to determine the function of stool control. Results There was no significant difference in the maximum resting pressure of anal canal, HPZ, the maximum systolic pressure of the anal canal and the Wexner in the three groups. Multiple variable ROC model regression analysis was used to analyze the influencing degree on the function of the stool, and the results showed that the Wexner score, HPZ, the maximum resting pressure of the anal canal, and the maximum systolic pressure had an obvious effect on the ability to control the stool, in which the HPZ correlated most predominately (P<0.01, HR=1.74, 95％CI 1.49- 2.03), and the age and sex factors were not selected in the equation. Conclusions Inter sphincter resection combined with new adjuvant therapy can effectively improve the anal fecal control ability of patients with low rectal cancer. The change of HPZ is of significance for prejudging the severity of fecal incontinence, which is worthy of further study.