Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 529-538
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.529
To explore the pathogenesis of anterior resection syndrome by magnetic resonance imaging rectal defecography
Ling-Hou Meng, Xian-Wei Mo, Bing-Yu Yang, Hai-Quan Qin, Qing-Zhou Song, Xin-Xin He, Qiang Li, Zheng Wang, Chang-Lin Mo, Guo-Hai Yang
Ling-Hou Meng, Bing-Yu Yang, Hai-Quan Qin, Qing-Zhou Song, Xin-Xin He, Chang-Lin Mo, Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Xian-Wei Mo, Department of Colorectal and Anal Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Qiang Li, Zheng Wang, Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Guo-Hai Yang, First Department of Chemotherapy, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Co-first authors: Ling-Hou Meng and Bing-Yu Yang.
Author contributions: Qin HQ, He XX and Li Q collected the data; Wang Z, Mo CL, Song QZ and Yang GH analyzed the data; Mo CL and Mo XW discussed the results and revised the final manuscript. All authors critically revised the manuscript and approved of the final version. All authors had full access to all the data in the study and accept responsibility to submit for publication. Together, Meng LH and Yang BY paid the time and energy needed to complete the research and the final paper, assumed the related responsibilities and burdens, and completed the design, preparation, submission and other steps of this research. This also ensures that the quality and reliability of the paper is ultimately improved. And, Meng LH and Yang BY contributed efforts of equal substance throughout the research process, made the most significant intellectual contribution and contributed equally to this work. The choice of these researchers as co-authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study.
Institutional review board statement: The study was reviewed and approved by the Guangxi Medical University Cancer Hospital (Guangxi).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xian-Wei Mo, MD, PhD, Chief Physician, Doctor, Professor, Department of Colorectal and Anal Surgery, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. moxianwei888@163.com
Received: October 7, 2023
Peer-review started: October 7, 2023
First decision: November 12, 2023
Revised: November 26, 2023
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: February 27, 2024
Processing time: 140 Days and 23 Hours
Abstract
BACKGROUND

Over 90% of rectal cancer patients develop low anterior resection syndrome (LARS) after sphincter-preserving resection. The current globally recognized evaluation method has many drawbacks and its subjectivity is too strong, which hinders the research and treatment of LARS.

AIM

To evaluate the anorectal function after colorectal cancer surgery by quantifying the index of magnetic resonance imaging (MRI) defecography, and pathogenesis of LARS.

METHODS

We evaluated 34 patients using the standard LARS score, and a new LARS evaluation index was established using the dynamic images of MRI defecography to verify the LARS score.

RESULTS

In the LARS score model, there were 10 (29.41%) mild and 24 (70.58%) severe cases of LARS. The comparison of defecation rate between the two groups was 29.36 ± 14.17% versus 46.83 ± 18.62% (P = 0.004); and MRI-rectal compliance (MRI-RC) score was 3.63 ± 1.96 versus 7.0 ± 3.21 (P = 0.001). Severe and mild LARS had significant differences using the two evaluation methods. There was a significant negative correlation between LARS and MRI-RC score (P < 0.001), and they had a negative correlation with defecation rate (P = 0.028).

CONCLUSION

MRI defecography and standard LARS score can both be used as an evaluation index to study the pathogenesis of LARS.

Keywords: Anterior resection syndrome; Colorectal cancer; Diagnostic evaluation system; Magnetic resonance imaging defecography; Pathogenesis

Core Tip: Currently, the evaluation of low anterior resection syndrome (LARS) symptoms in patients is solely reliant on subjective measures, such as questionnaires. There is a lack of a standardized and objective medical assessment index. We innovatively used magnetic resonance imaging (MRI) defecography to judge and quantify the compliance of neorectum after rectal cancer surgery. We established the objective diagnosis and severity evaluation criteria for LARS MRI defecography, quantify the severity of LARS by objective clinical evaluation index, which promotes the exploration of the pathogenesis of LARS.