Analysis of presacral tissue structure in LARS and the prevention of LARS by reconstruction of presacral mesorectum with pedicled greater omentum flap graft.
Low anterior resection syndrome
Low rectal cancer
Mesorectum
Omental pedicle flap
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
26
01
2021
accepted:
04
09
2021
pubmed:
29
9
2021
medline:
15
12
2021
entrez:
28
9
2021
Statut:
ppublish
Résumé
The greater omentum has played a unique biological role in regenerative surgery. The aim of our study was to alter the anterior sacral structure by filling the anterior sacral space with the greater omentum and evaluate its effect on the low anterior resection syndrome (LARS) after total mesorectal excision (TME) surgery for low rectal cancer. We retrospectively collected clinical data of patients with primary low rectal cancer who underwent TME and ileostomy closure in our hospital from March 2018 to March 2020. Spearman correlation analysis was conducted to analyze the correlation between postoperative mesorectal fascia (MRF) thickness and LARS score. Subsequently, we prospectively used a tipped greater omental flap graft to reconstruct the anterior rectal sacral structures (MRF reconstruction) in 17 patients and compared LARS scores and rectal compliance (RC) at week 12 after closure of the ileostomy in both groups. There were 47 patients with No-MRF reconstruction (31 males, mean age 60.68 ± 9.21 years) and 17 with MRF reconstruction (10 males, mean age 49.82 ± 14.74 years). Correlation analysis indicated that MRF thickness and RC were negatively correlated with LARS severity (p < 0.05). The LARS score of patients with MRF reconstruction at 12 weeks was significantly better than that of those with No-MRF reconstruction (32.97 ± 2.65 vs. 26.94 ± 1.52, p = 0.001), and the RC of MRF reconstruction were lower (2.80 ± 0.55 vs. 3.67 ± 0.38, p = 0.001). In addition, MRF reconstruction and No-MRF reconstruction have the similar incidence of postoperative complications (p = 0.156). No hemorrhage or necrosis of the greater omentum flap was observed in any of the patients. Greater omentum flap transplantation can significantly improve the symptoms of LARS at 12 weeks after ileostomy closure and we expect it to become a new surgical procedure for the treatment of low rectal cancer.
Sections du résumé
BACKGROUND
BACKGROUND
The greater omentum has played a unique biological role in regenerative surgery. The aim of our study was to alter the anterior sacral structure by filling the anterior sacral space with the greater omentum and evaluate its effect on the low anterior resection syndrome (LARS) after total mesorectal excision (TME) surgery for low rectal cancer.
METHODS
METHODS
We retrospectively collected clinical data of patients with primary low rectal cancer who underwent TME and ileostomy closure in our hospital from March 2018 to March 2020. Spearman correlation analysis was conducted to analyze the correlation between postoperative mesorectal fascia (MRF) thickness and LARS score. Subsequently, we prospectively used a tipped greater omental flap graft to reconstruct the anterior rectal sacral structures (MRF reconstruction) in 17 patients and compared LARS scores and rectal compliance (RC) at week 12 after closure of the ileostomy in both groups.
RESULTS
RESULTS
There were 47 patients with No-MRF reconstruction (31 males, mean age 60.68 ± 9.21 years) and 17 with MRF reconstruction (10 males, mean age 49.82 ± 14.74 years). Correlation analysis indicated that MRF thickness and RC were negatively correlated with LARS severity (p < 0.05). The LARS score of patients with MRF reconstruction at 12 weeks was significantly better than that of those with No-MRF reconstruction (32.97 ± 2.65 vs. 26.94 ± 1.52, p = 0.001), and the RC of MRF reconstruction were lower (2.80 ± 0.55 vs. 3.67 ± 0.38, p = 0.001). In addition, MRF reconstruction and No-MRF reconstruction have the similar incidence of postoperative complications (p = 0.156). No hemorrhage or necrosis of the greater omentum flap was observed in any of the patients.
CONCLUSIONS
CONCLUSIONS
Greater omentum flap transplantation can significantly improve the symptoms of LARS at 12 weeks after ileostomy closure and we expect it to become a new surgical procedure for the treatment of low rectal cancer.
Identifiants
pubmed: 34581900
doi: 10.1007/s10151-021-02521-9
pii: 10.1007/s10151-021-02521-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1291-1300Subventions
Organisme : Self-Financing Research Project of the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region
ID : Z2015607
Organisme : Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project
ID : S2017098
Organisme : 2019 Guangxi University High-level Innovation Team and the Project of Outstanding Scholars Program, and Guangxi Science and Technology Project
ID : 2019AC03004
Organisme : Guangxi Science and Technology Base and Talent Project
ID : AD19245197
Informations de copyright
© 2021. Springer Nature Switzerland AG.
Références
Jin G (2006) Surgical surgery for low rectal cancer. J Oncol 01:27–30
Tytherleigh MG, Mc CMNJ (2003) Options for sphincter preservation in surgery for low rectal cancer. Br J Surg 90(8):922–933. https://doi.org/10.1002/bjs.4296
doi: 10.1002/bjs.4296
pubmed: 12905543
Ghareeb WM, Wang X, Chi P, Wang W (2020) The “multilayer” theory of Denonvilliers’ fascia: anatomical dissection of cadavers with the aim to improve neurovascular bundle preservation during rectal mobilization. Colorectal Dis 22(2):195–202. https://doi.org/10.1111/codi.14850
doi: 10.1111/codi.14850
pubmed: 31496016
Nguyen TH, Chokshi RV (2020) Low anterior resection syndrome. Curr Gastroenterol Rep 22(10):48. https://doi.org/10.1007/s11894-020-00785-z
doi: 10.1007/s11894-020-00785-z
pubmed: 32749603
pmcid: 8370104
Croese AD, Zubair ON, Lonie J, Trollope AF, Vangaveti VN, Mushaya C, Ho YH (2018) Prevalence of low anterior resection syndrome at a regional Australian centre. ANZ J Surg 88(12):E813-e817. https://doi.org/10.1111/ans.14749
doi: 10.1111/ans.14749
pubmed: 30117652
Lembo T, Munakata J, Mertz H, Niazi N, Kodner A, Nikas V, Mayer EA (1994) Evidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome. Gastroenterology 107(6):1686–1696. https://doi.org/10.1016/0016-5085(94)90809-5
doi: 10.1016/0016-5085(94)90809-5
pubmed: 7958680
Di Nicola V (2019) Omentum a powerful biological source in regenerative surgery. Regen Therapy 11:182–191. https://doi.org/10.1016/j.reth.2019.07.008
doi: 10.1016/j.reth.2019.07.008
Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255(5):922–928. https://doi.org/10.1097/SLA.0b013e31824f1c21
doi: 10.1097/SLA.0b013e31824f1c21
pubmed: 22504191
Hou XT, Pang D, Lu Q, Yang P, Jin SL, Zhou YJ, Tian SH (2015) Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients. Eur J Oncol Nurs 19(5):495–501. https://doi.org/10.1016/j.ejon.2015.02.009
doi: 10.1016/j.ejon.2015.02.009
pubmed: 25813530
Felt-Bersma RJ, Sloots CE, Poen AC, Cuesta MA, Meuwissen SG (2000) Rectal compliance as a routine measurement: extreme volumes have direct clinical impact and normal volumes exclude rectum as a problem. Dis Colon Rectum 43(12):1732–1738. https://doi.org/10.1007/bf02236859
doi: 10.1007/bf02236859
pubmed: 11156459
Silen W (1993) Mesorectal excision for rectal cancer. Lancet (London, England) 341(8855):1279–1280. https://doi.org/10.1016/0140-6736(93)91182-l
doi: 10.1016/0140-6736(93)91182-l
Tuson JR, Everett WG (1990) A retrospective study of colostomies, leaks and strictures after colorectal anastomosis. Int J Colorectal Dis 5(1):44–48. https://doi.org/10.1007/bf00496150
doi: 10.1007/bf00496150
pubmed: 2313156
Pucciani F (2013) A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updat Surg 65(4):257–263. https://doi.org/10.1007/s13304-013-0220-5
doi: 10.1007/s13304-013-0220-5
Lee SJ, Park YS (1998) Serial evaluation of anorectal function following low anterior resection of the rectum. Int J Colorectal Dis 13(5–6):241–246. https://doi.org/10.1007/s003840050169
doi: 10.1007/s003840050169
pubmed: 9870169
Nesbakken A, Nygaard K, Lunde OC (2002) Mesorectal excision for rectal cancer: functional outcome after low anterior resection and colorectal anastomosis without a reservoir. Colorectal Dis 4(3):172–176. https://doi.org/10.1046/j.1463-1318.2002.00305.x
doi: 10.1046/j.1463-1318.2002.00305.x
pubmed: 12780611
Ulrich A, Z’Graggen K, Weitz J, Büchler MW (2005) Functional results of the colon J-pouch versus transverse coloplasty pouch in Heidelberg. Recent Results Cancer Res Fortschritte Krebsforschung Progr Dans Rech Sur Cancer 165:205–211. https://doi.org/10.1007/3-540-27449-9_22
doi: 10.1007/3-540-27449-9_22
Rink AD, Sgourakis G, Sotiropoulos GC, Lang H, Vestweber KH (2009) The colon J-pouch as a cause of evacuation disorders after rectal resection: myth or fact? Langenbecks Arch Surg 394(1):79–91. https://doi.org/10.1007/s00423-008-0364-9
doi: 10.1007/s00423-008-0364-9
pubmed: 18651168
Suzuki H, Matsumoto K, Amano S, Fujioka M, Honzumi M (1980) Anorectal pressure and rectal compliance after low anterior resection. Br J Surg 67(9):655–657. https://doi.org/10.1002/bjs.1800670917
doi: 10.1002/bjs.1800670917
pubmed: 7427068
Dal Lago A, Minetti AE, Biondetti P, Corsetti M, Basilisco G (2005) Magnetic resonance imaging of the rectum during distension. Dis Colon Rectum 48(6):1220–1227. https://doi.org/10.1007/s10350-004-0933-0
doi: 10.1007/s10350-004-0933-0
Morihiro M, Koda K, Seike K, Miyauchi H, Miyazaki M (2008) Characteristic findings on defecography according to reconstruction method and defecatory disorder following sphincter-saving surgery for rectal cancer. Int J Colorectal Dis 23(9):883–892. https://doi.org/10.1007/s00384-008-0485-1
doi: 10.1007/s00384-008-0485-1
pubmed: 18509660
Iizuka I, Koda K, Seike K, Shimizu K, Takami Y, Fukuda H, Tsuchida D, Oda K, Takiguchi N, Miyazaki M (2004) Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer. Am J Surg 188(2):176–180. https://doi.org/10.1016/j.amjsurg.2003.12.064
doi: 10.1016/j.amjsurg.2003.12.064
pubmed: 15249246
Madoff RD, Orrom WJ, Rothenberger DA, Goldberg SM (1990) Rectal compliance: a critical reappraisal. Int J Colorectal Dis 5(1):37–40. https://doi.org/10.1007/bf00496148
doi: 10.1007/bf00496148
pubmed: 2313155
Goldsmith HS, Chen WF, Duckett SW (1973) Brain vascularization by intact omentum. Arch Surg 106(5):695–698. https://doi.org/10.1001/archsurg.1973.01350170061015
doi: 10.1001/archsurg.1973.01350170061015
pubmed: 4701418
Bikfalvi A, Alterio J, Inyang AL, Dupuy E, Laurent M, Hartmann MP, Vigny L, Raulais D, Courtois Y, Tobelem G (1990) Basic fibroblast growth factor expression in human omental microvascular endothelial cells and the effect of phorbol ester. J Cell Physiol 144(1):151–158. https://doi.org/10.1002/jcp.1041440120
doi: 10.1002/jcp.1041440120
pubmed: 1694858
Shafik A (1991) Idiopathic oligofecorrhea: a clinicopathologic entity–pathogenesis and treatment. Digestion 48(1):51–58. https://doi.org/10.1159/000200663
doi: 10.1159/000200663
pubmed: 1868968