ヤマグチ　シゲキ   YAMAGUCHI Shigeki   山口　茂樹    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	A multicentre prospective study of anal function after laparoscopic ultra-low rectal cancer surgery using a mixed-effects model
掲載誌名	正式名：Colorectal disease 略　 称：Colorectal Dis ISSNコード：14631318/14628910
掲載区分	国外
巻・号・頁	27(5),pp.e70129
著者・共著者	TAKAHASHI Makoto,SAKAMOTO Kazuhiro,TSUKADA Yuichiro, KAWANO Shingo,WATANABE Jun,FUKUNAGA Yosuke,HIRANO Yasumitsu,HAMAMOTO Hiroki,YOSHIMITSU Masanori,HORIE Hisanaga,MATSUHASHI Nobuhisa,KURIU Yoshiaki,NAGAI Shuntaro,HAMADA Madoka,YOSHIOKA Shinichi,OHMURA Shinobu,HAYAMA Tamuro,OTSUKA Koki,INOUE Yusuke,UEDA KazukiTOIYAMA, Yuji,MARUYAMA Satoshi,YAMAGUCHI Shigeki,TANAKA Keitaro,SUZUKI Motoko,MISUMI Toshihiro,NAITOH Takeshi,WATANABE Masahiko,ITO Masaaki
発行年月	2025/05
概要	AIM:Abdominoperineal resection with permanent colostomy has historically been performed for very low rectal cancer located near the anal canal. Anus-preserving surgeries, such as intersphincteric resection (ISR) and low anterior resection (LAR), have recently become more common. However, postoperative anal function is a concern in these surgeries when the anastomosis is very low. The aim of this study was to examine changes in anal function and factors that worsen anal function after surgery for rectal cancer.METHOD:A multicentre (47 facilities), non-randomized, single-arm phase II trial was conducted prospectively using the Wexner score questionnaire between 2014 and 2017. A total of 278 patients who underwent laparoscopic surgery for clinical Stage I very low rectal cancer were analysed using a mixed-effects model.RESULTS:Anal function temporarily worsened 3 months after surgery, but gradually recovered and spontaneously returned to an acceptable level in 3 years. In a comparison of surgical procedures, anal function was significantly better after LAR than after any type of ISR. There was little difference in anal function after total ISR, subtotal ISR and partial ISR. In the mixed-effects model analysis, ISR and older age (≥75 years) were identified as independent factors that worsened postoperative anal function.CONCLUSIONS:The results showed early deterioration of anal function followed by gradual improvement to an acceptable level after surgery. There is a higher risk of poor postoperative anal function after ISR and in older patients, and these risk factors should be communicated to patients when obtaining consent for the surgery.
DOI	10.1111/codi.70129
PMID	40415353