ObjectiveTo analyze the independent risk factors of mid-term defecation dysfunction after transanal total mesorectal excision (TaTME) in patients with low rectal cancer, and establish a nomogram model.
MethodsA total of 172 patients with low rectal cancer who received laparoscopic assisted TaTME from January 2016 to January 2020 were selected as the training group, and 32 patients who received the same operation from February 2020 to February 2021 were selected as the validation group; the patients in training group were divided into LARS and non-LARS group according to the occurrence of low anterior resection syndrome (LARS) at the follow-up of 6 months after surgery.The medical records of the patients in two groups were compared.The independent risk factors affecting the occurrence of LARS were analyzed by using univariate and multivariate logistic regression models.The nomogram model for predicting the LARS in low rectal cancer patients after TaTME was established by using R software and validated.
ResultsThe LARS score of patients was (14.78±4.54) points, including 84 LARS patients (48.84%) and 88 non-LARS patients (51.16%).Univariate and multivariate logistic regression analysis showed that preoperative radiotherapy, anal sphincter injury, distance between anastomotic stoma and anal margin, tumor diameter, and length of ischial spine were independent risk factors for LARS (P < 0.05 to P < 0.01).The C-indexes of the nomogram model in both training group and validation group were are 0.836 and 0.827, respectively.ROC curve showed that the AUCs of the nomogram model in both training group and validation group were 0.829 and 0.808, respectively.
ConclusionsPreoperative radiotherapy, anal sphincter injury, anastomotic distance from anal margin, tumor diameter, and ischial interspinous diameter are the independent risk factors for LARS.The nomogram model established with the above indicators has good predictive efficacy.
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