title: Is the interval from surgery to ileostomy closure a risk factor for low anterior resection syndrome?
abstract: OBJECTIVE
  Low anterior resection syndrome (LARS) comprises a collection of symptoms affecting patients after restorative surgery for rectal cancer. The aim of the present study was to analyse the incidence of LARS in patients undergoing rectal cancer surgery with and without subsequent ileostomy and to determine whether the interval to ileostomy closure is a factor associated with its occurrence.
  
  
  METHODS
  All patients undergoing curative anterior resection for rectal cancer from 2008 to 2012 in our institution were included in the study. They were divided into two groups according to whether or not a defunctioning ileostomy had been performed. Patients were assessed for LARS at a median interval of 23.60 ± 16.73 (12-48) months from anterior resection in those who did not have an ileostomy and at an interval of 11.31 ± 14.24 (12-60) months from closure of the ileostomy in those who did. They underwent a structured telephone interview based on a validated LARS score questionnaire. Univariate and multivariate analysis was carried out to assess possible associations between LARS and the variables studied.
  
  
  RESULTS
  There were 150 patients (93 men) of whom 54.7% had no evidence of LARS, 17.3% had minor symptoms and 28% major symptoms of LARS. Univariate analysis showed that male gender, the presence of a temporary ileostomy and neoadjuvant therapy were predisposing factors for LARS. The interval from construction of the ileostomy to its closure did not appear to be a factor associated with LARS. In multivariate analysis, male gender and preoperative neoadjuvant therapy were significant predisposing factors for LARS.
  
  
  CONCLUSIONS
  Male gender and preoperative neoadjuvant therapy are risk factors for LARS. The presence of ileostomy or time to ileostomy closure is not associated with the development of this syndrome.
authors.affiliation: Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: R M
authors.initials: RM
authors.lastname: Jiménez-Rodríguez
authors.affiliation: Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain.|General & Digestive Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: J J
authors.identifier: http://orcid.org/0000-0003-0565-3791
authors.initials: JJ
authors.lastname: Segura-Sampedro
authors.affiliation: Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Rivero-Belenchón
authors.affiliation: Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Díaz Pavón
authors.affiliation: Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: A M
authors.initials: AM
authors.lastname: García Cabrera
authors.affiliation: Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Vazquez Monchul
authors.affiliation: Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Padillo
authors.affiliation: Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: F
authors.initials: F
authors.lastname: de la Portilla
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003106:Colon / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects* / Q000379:methods; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors
keywords: Anterior resection syndrome; ileostomy closure; rectal cancer