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Low Anterior Resection Syndrome (LARS) is a common postoperative bowel dysfunction in patients undergoing sphincter-preserving surgery for rectal cancer. Symptoms include fecal and gas incontinence, urgency, increased bowel frequency, and fragmented evacuations. LARS significantly impairs quality of life, affecting up to 90% of patients. Various factors contribute to its development, such as tumor height, extent of mesorectal excision, preoperative radiotherapy, and ileostomy. However, these factors are less studied in South American populations, where racial, cultural, and healthcare system differences may influence outcomes.
The aim of the study was to evaluate risk factors associated with LARS in a Chilean cohort of rectal cancer patients, with emphasis on cases classified as severe.
A non-concurrent prospective cohort study including patients who underwent low anterior resection between 2012 and 2021. Perioperative data collected included tumor height, surgical procedure type, preoperative radiotherapy, and protective ileostomy. Univariate and multivariate analyses were conducted to identify factors significantly associated with severe LARS, using the LARS score adapted to Chilean Spanish.
A total of 110 patients were included, with a median follow-up of 51 months. LARS was identified in 52.7% of cases, with 29.1% classified as major. Younger age, lower tumors, total mesorectal excision, preoperative radiotherapy, and ileostomy were significantly associated with severe LARS in univariate analysis. In multivariate analysis, only younger age and preoperative radiotherapy remained as independent risk factors.
In this Chilean cohort, nearly half of patients undergoing sphincterpreserving surgery for rectal cancer developed LARS. About one-third had the severe form, highlighting the need for targeted strategies to mitigate LARS and improve patient quality of life.
Colon cancer is the third most common malignancy in Colombia, only exceeded by prostate and breast cancers. It is the second most common cancer among females and the third most common among males. The epidemiology of this disease has changed in Colombia, and its peak incidence has now surpassed that of gastric cancer.
We aimed to determine the association between hospital surgical volume and mortality in patients with colon cancer undergoing surgical resection in Colombia.
This was a national retrospective cohort study based on administrative data and included adult patients undergoing surgical resection for colon cancer who were enrolled in Colombia’s contributory health system between 2012 and 2017. We defined exposure as the hospital’s surgical volume where the colon cancer surgery was performed. We classified the patients as exposed to a high surgical volume (above the 90th percentile of the provider distribution) and a low surgical volume (under the 90th percentile). The main outcomes were 30-day and 1-year mortality. Multivariate Poisson regressions were used to identify the association between exposure and mortality rates.
The study included 4,647 patients, of which 4,188 underwent surgery at hospitals with a colectomy volume lower than 33 per year and 459 underwent surgery at institutions with volumes equal to or higher than 33 per year. In the multivariate analysis, after adjusting for observable variables, a lower risk of 30-day mortality was found in patients who underwent surgery at high surgical volume institutions (relative risk - RR 0.57, 95% confidence interval - 95%CI 0.033-0.97). No differences were found in the one-year mortality.
The high surgical volume of a hospital is associated with a 30-day mortality in colon cancer, as described in other studies, but the 1-year mortality did not show this association. Prospective studies are required to establish a causal relationship.
Desenvolvido por Surya MKT