title: Anterior resection syndrome--a risk factor analysis.
abstract: BACKGROUND
  Evacuatory dysfunction after distal colorectal resection varies from incontinence to obstructed defaecation and is termed anterior resection syndrome. The aim of this study was to identify risk factors for the development of anterior resection syndrome.
  
  
  METHODS
  All anterior resections undertaken at Auckland Hospital from 2002 to 2012 were retrospectively evaluated. An assortment of patient and peri-operative variables were recorded. Cases were stratified by the occurrence of anterior resection syndrome symptoms from 1 to 5 years post-operatively.
  
  
  RESULTS
  A total of 277 patients were identified. Prevalence of anterior resection syndrome decreased progressively from 61 % at 1 year to 43 % at 5 years. Univariate analysis identified anastomotic height, surgeon, pT stage, procedure year and temporary diversion ileostomy as recurring significant correlates (p < 0.05). Logistic regression identified lower anastomotic height (odds ratio (OR) 2.11, 95 % confidence interval (CI) 1.05-4.27; p = 0.04) and obstructive presenting symptoms (OR 6.71, 95 % CI 1.00-44.80; p = 0.05) as independent predictors at 1 and 2 years, respectively. Post-operative chemotherapy was a predictor at 1 year (OR 1.93, 95 % CI 1.04-3.57; p = 0.03). Temporary diverting ileostomy was an independent predictor at 2 (OR 2.49, 95 % CI 1.04-5.95; p = 0.04), 3 (OR 4.17, 95 % CI 1.04-16.78; p = 0.04), 4 (OR 8.05, 95 % CI 1.21-53.6; p = 0.03), and 5 years (OR 49.60, 95 % CI 2.17-1134.71; p = 0.02) after adjusting for anastomotic height.
  
  
  CONCLUSIONS
  Anastomotic height, post-operative chemotherapy and obstructive presenting symptoms were independent predictors at 1 and 2 years. Temporary diversion ileostomy was an independent predictor for the occurrence of anterior resection syndrome at 2, 3, 4 and 5 years even after correcting for anastomotic height. Prospective assessment is required to facilitate more accurate risk factor analysis.
authors.affiliation: Department of Surgery, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
authors.forename: Cameron I
authors.initials: CI
authors.lastname: Wells
authors.forename: Ryash
authors.initials: R
authors.lastname: Vather
authors.forename: Michael J J
authors.initials: MJ
authors.lastname: Chu
authors.forename: Jason P
authors.initials: JP
authors.lastname: Robertson
authors.forename: Ian P
authors.initials: IP
authors.lastname: Bissett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D003248:Constipation / Q000209:etiology*; D003672:Defecation; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents