講演情報
[INTS2-6]The Impact of Low Anterior Resection Syndrome on Quality of Life After Hartmann Reversal
*Shiki Fujno1,2, Osanna Wong2, Naoki Yoneda1, Ayumi Nagae1, Genta Sawada1, Shunji Morita1, Thang Chien Nguyen2, William Teoh2, Hanumant Chouhan2, Thomas Suhardja2 (1. Department of surgery, Itami City Hospital, Japan, 2. Department of Colorectal Surgery, Dandenong Hospital, Monash Health)
Background: Restoration of intestinal continuity after Hartmann’s procedure (HP) is expected to improve postoperative quality of life (QoL). However, bowel dysfunction resembling low anterior resection syndrome (LARS) may occur after Hartmann reversal (HR), and its clinical impact has not been fully clarified. We evaluated postoperative QoL after HP and HR, with additional assessment of patients who developed LARS following reversal.
Methods: Patients who underwent HP or HR at a tertiary referral center were retrospectively reviewed. Approximately 1 year after surgery, QoL was assessed using the Colorectal Surgery Quality of Life Questionnaire-35 and the LARS score. Domains analyzed included physical and emotional wellbeing, work productivity, self-image, sexual function, and stoma-related burden. Comparisons between groups were performed using nonparametric and categorical statistical analyses.
Results: A total of 91 patients were included (HP, n=50; HR, n=41). Patients undergoing HR showed significantly higher scores for physical wellbeing and work productivity compared with those living with a permanent stoma. These associations remained significant after adjustment for age and sex. Major LARS was observed in 17% of HR patients. Patients with LARS demonstrated markedly impaired physical wellbeing and worse sexual function than those without LARS. In addition, all patients with LARS indicated that they would accept or prefer a stoma if given the choice.
Conclusions: HR was associated with favorable postoperative QoL overall; however, postoperative bowel dysfunction substantially affected outcomes in a subset of patients. Preoperative counseling regarding the potential risk of LARS and individualized decision-making are essential when considering reversal surgery.
Methods: Patients who underwent HP or HR at a tertiary referral center were retrospectively reviewed. Approximately 1 year after surgery, QoL was assessed using the Colorectal Surgery Quality of Life Questionnaire-35 and the LARS score. Domains analyzed included physical and emotional wellbeing, work productivity, self-image, sexual function, and stoma-related burden. Comparisons between groups were performed using nonparametric and categorical statistical analyses.
Results: A total of 91 patients were included (HP, n=50; HR, n=41). Patients undergoing HR showed significantly higher scores for physical wellbeing and work productivity compared with those living with a permanent stoma. These associations remained significant after adjustment for age and sex. Major LARS was observed in 17% of HR patients. Patients with LARS demonstrated markedly impaired physical wellbeing and worse sexual function than those without LARS. In addition, all patients with LARS indicated that they would accept or prefer a stoma if given the choice.
Conclusions: HR was associated with favorable postoperative QoL overall; however, postoperative bowel dysfunction substantially affected outcomes in a subset of patients. Preoperative counseling regarding the potential risk of LARS and individualized decision-making are essential when considering reversal surgery.