Factors Affecting Low Anterior Resection Syndrome following Anus-Preserving Surgery for Rectal Cancer and Assessing the Impact of Nursing Interventions in Rapid Rehabilitation Surgery.

ABSTRACT

Background and objective: This study aimed to investigate the factors affecting the development of low anterior resection syndrome (LARS) following anus-preserving surgery for rectal cancer, and to assess the impact of a rapid rehabilitation surgical nursing intervention on patient outcomes. LARS is a significant issue for patients undergoing these surgeries, as it can severely impact quality of life. Understanding the risk factors for LARS is crucial to develop targeted interventions to improve post-operative recovery. Methods: The study retrospectively analyzed the clinical data of 78 rectal cancer patients who underwent anus-preserving radical resection. The occurrence of LARS was assessed using the LARS score scale. Univariate and multivariate logistic regression analyses were performed to identify factors that may affect the development of LARS, including distance of the anastomosis from the anal verge, preoperative chemoradiotherapy, and postoperative anastomotic leakage. Additionally, the study compared outcomes between two patient groups - a control group receiving routine surgical nursing care, and an experimental group receiving a rapid rehabilitation surgical nursing intervention. This intervention included preoperative patient education, optimized anesthesia and surgical techniques, and intensive postoperative rehabilitation. Key outcomes measured included time to first flatus, time to first defecation, duration of pain-free days, length of hospital stay, and total hospitalization costs. Results: The univariate regression analysis showed that the distance from the anastomosis to the anal verge (OR=4.364, P < .001, 95% CI 2.732-7.257), preoperative chemoradiotherapy (OR=9.135, P = .004, 95% CI 1.963-40.316), and postoperative anastomotic leakage (OR=2.636, P < .001, 95% CI 1.641-4.245) were significant risk factors for the development of LARS. The multivariate logistic regression analysis confirmed that a shorter distance between the anastomosis and anal margin, preoperative radiotherapy, and postoperative anastomotic leakage were independent predictors of LARS (all P < .05). Comparison of the two patient groups showed that the rapid rehabilitation surgical nursing intervention had a significant positive impact. Patients in the experimental group (group E) had a significantly shorter time to first exhaust (62.19±7.43 minutes vs. 96.18±10.62 minutes in group C, P < .001) and first defecation (85.26±8.41 minutes vs. 130.26±12.38 minutes in group C, P < .001). Group E also experienced a longer duration of 0 pain score days (3.57±0.72 days vs. 5.42±1.05 days in group C, P < .001), shorter hospital stays (10.15±2.05 days vs. 15.33±1.23 days in group C, P < .001), and lower total hospitalization costs (31.80±3.70 thousand Yuan vs. 42.80±5.60 thousand Yuan in group C, P < .001). Conclusion: This study identified the distance between the anastomosis and anal margin, preoperative radiotherapy, and postoperative anastomotic leakage as independent risk factors for the development of LARS in patients undergoing anus-preserving surgery for rectal cancer. These findings can inform preoperative risk assessment and guide surgical planning to mitigate the risk of LARS. Patients identified as high-risk may benefit from more intensive preoperative counseling and targeted nursing interventions to optimize postoperative bowel function. Notably, the rapid rehabilitation surgical nursing intervention demonstrated significant benefits in accelerating patient recovery, reducing complications, and lowering overall healthcare utilization. This comprehensive nursing approach, encompassing preoperative education, optimized perioperative management, and intensive postoperative rehabilitation, offers a promising model to improve standards of care for rectal cancer patients undergoing anus-preserving surgeries. Widespread adoption of such targeted nursing interventions has the potential to enhance patient outcomes, quality of life, and healthcare resource efficiency in this patient population.