The impact of adjuvant chemotherapy on the occurrence of low anterior resection syndrome within 6 months after sphincter-preserving surgery for rectal cancer: a study based on the DACCA database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yujie ¹ , WU Haoying ² , WANG Xiaodong ³ , WANG Sutong ⁴ ,  HUANG Mingjun ⁵

1. West China School of Nursing, Sichuan University / Day Surgery Center of General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
3. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Business School, Sichuan University, Chengdu 610041, P. R. China;
5. Day Surgery Center of General Practice Medical Center / West China School of Nursing, West China Hospital, Sichuan University,Chengdu 610041, P. R. China;

Corresponding?author：

HUANG Mingjun, Email: huangmingjun@wchscu.cn

Keywords：

rectal cancer; postoperative adjuvant chemotherapy; sphincter-preserving; low anterior resection syndrome

DOI：

10.7507/1007-9424.202605059

Video：

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Objective To investigate the effect of postoperative adjuvant chemotherapy on the occurrence of low anterior resection syndrome (LARS) at 6 months after sphincter-preserving surgery for rectal cancer. Methods Data of patients who underwent sphincter-preserving surgery for rectal cancer was extracted from the West China Database from Colorectal Cancer (DACCA, updated August 2022 version) to analyse LARS at 1, 3 and 6 months postoperatively. Multivariate logistic regression analyses was employed to explore the influence factors associated with LARS at 6 months postoperatively. Results A total of 207 patients were included, of whom 100 received postoperative adjuvant chemotherapy and 107 did not. In patients who received postoperative adjuvant chemotherapy and not received postoperative adjuvant chemotherapy, there was no statistically significant difference in occurrence rate of LARS at 1 [35.0% (35/100) vs. 44.9% (48/107), χ²=2.092, P=0.148], 3 [33.0% (33/100) vs. 34.6% (37/107), χ²=0.058, P=0.810] and 6 [20.0% (20/100) vs. 23.4% (25/107), χ²=0.344, P=0.558] months after surgery between them. Multivariate analysis result further showed that ultra-low anterior resection was a risk factor for LARS at 6 months postoperatively compared with high anterior resection (OR=7.651, P=0.005). Stoma (OR=1.319, P=0.621), intestinal obstruction (OR=0.585, P=0.168) and postoperative adjuvant chemotherapy (OR=1.183, P=0.654) had no statistically significant effect on LARS at 6 months postoperatively. Conclusion Postoperative adjuvant chemotherapy has no statistically significant effect on the occurrence of LARS at 6 months after sphincter-preserving surgery for rectal cancer.

Citation： LI Yujie, WU Haoying, WANG Xiaodong, WANG Sutong, HUANG Mingjun. The impact of adjuvant chemotherapy on the occurrence of low anterior resection syndrome within 6 months after sphincter-preserving surgery for rectal cancer: a study based on the DACCA database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1038-1046. doi: 10.7507/1007-9424.202605059 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Shi JF, Wang L, Ran JC, et al. Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: overall design and results from a multicenter retrospective epidemiologic survey [J]. Cancer, 2021, 127(11): 1880-1893.
3.	Solitano V, Vuyyuru SK, Yuan Y, et al. Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium [J/OL]. Int J Colorectal Dis, 2024, 39(1): 147. doi: 10.1007/s00384-024-04714-8.
4.	李楊, 李心翔, 崔龍, 等. 中國結直腸癌手術病例登記數據庫2025年度報告: 一項全國性前瞻性登記研究 [J]. 中國實用外科雜志, 2026, 46(2): 239-246.
5.	Keane C, Fearnhead NS, Bordeianou LG, et al. International consensus definition of low anterior resection syndrome [J]. Dis Colon Rectum, 2020, 63(3): 274-284.
6.	吳曉華, 牛志新, 何峰, 等. 320例老年直腸癌保肛術后低位前切除綜合征的危險因素分析 [J]. 臨床消化病雜志, 2023, 35(4): 316-319.
7.	張蕊, 孫曉林, 張光云, 等. 直腸癌保肛術后低位前切除綜合征發生情況及危險因素分析 [J]. 實用癌癥雜志, 2023, 38(7): 1187-1189, 1193.
8.	張文. 直腸癌保肛根治術后發生低位前切除綜合征的影響因素分析 [J]. 慢性病學雜志, 2026, 27(2): 190-193.
9.	Kung VWS, Broad J, Makwana R, et al. The impact of long-course chemoradiotherapy on the myenteric plexus, neuromuscular functions and responses to prokinetic drugs in the human rectum [J]. United European Gastroenterol J, 2024, 12(10): 1417-1428.
10.	Benli S, ?olak T, Türkmeno?lu M?. Factors influencing anterior/low anterior resection syndrome after rectal or sigmoid resections [J]. Turk J Med Sci, 2021, 51(2): 623-630.
11.	于瑞璇, 何欣林, 張秋露, 等. 華西DACCA的輔助研究: 單獨的新輔助化療不會影響直腸癌術后近期的肛門功能 [J]. 中國普外基礎與臨床雜志, 2019, 26(5): 595-601.
12.	Quezada-Diaz F, Jimenez-Rodriguez RM, Pappou EP, et al. Effect of neoadjuvant systemic chemotherapy with or without chemoradiation on bowel function in rectal cancer patients treated with total mesorectal excision [J]. J Gastrointest Surg, 2019, 23(4): 800-807.
13.	Zhang Q, An L, Yu R, et al. The impact of neoadjuvant chemotherapy on low anterior resection syndrome after rectal cancer resection: a 6 months longitudinal follow-up [J]. Asian J Surg, 2021, 44(10): 1260-1265.
14.	黃斌杰, 朱苗苗, 吳雅麗, 等. 低位直腸癌新輔助化療聯合保肛術后發生低位前切除綜合征的現況調查 [J]. 腹部外科, 2023, 36(6): 450-456, 462.
15.	胡海燕, 孫佳男, 張晴, 等. 直腸癌低位前切除綜合征發展軌跡的潛在類別及預測因素分析 [J]. 中國護理管理, 2024, 24(6): 819-824.
16.	Al-Rashid F, Robitaille S, Liberman AS, et al. Trajectory of change of low anterior resection syndrome over time after restorative proctectomy for rectal adenocarcinoma [J]. Tech Coloproctol, 2022, 26(3): 195-203.
17.	汪曉東, 曾渝, 李立. 數據庫建設第十部分: 結直腸癌輔助治療的標簽與結構化 [J]. 中國普外基礎與臨床雜志, 2021, 28(8): 1070-1077.
18.	汪曉東, 劉健博, 李立. 數據庫建設第五部分: 結直腸癌的腫瘤特征—模塊的設計(一) [J]. 中國普外基礎與臨床雜志, 2020, 27(3): 345-349.
19.	曹蘭玉, 魏力, 王春梅. 直腸癌前切除綜合征評分量表的漢化及信效度評價 [J]. 中國實用護理雜志, 2013, 29(27): 69-72.
20.	Farrokhi K, Marginean H, Al Ghamdi A, et al. The impact of adjuvant chemotherapy on clinical outcomes in locally advanced rectal cancer: a CHORD consortium analysis [J/OL]. Curr Oncol, 2025, 32(7): 371. doi: 10.3390/curroncol32070371.
21.	Ye L, Huang M, Huang Y, et al. Risk factors of postoperative low anterior resection syndrome for colorectal cancer: a meta-analysis [J]. Asian J Surg, 2022, 45(1): 39-50.
22.	Sun R, Dai Z, Zhang Y, et al. The incidence and risk factors of low anterior resection syndrome (LARS) after sphincter-preserving surgery of rectal cancer: a systematic review and meta-analysis [J]. Support Care Cancer, 2021, 29(12): 7249-7258.
23.	Zhang X, Meng Q, Du J, et al. Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient [J/OL]. Sci Rep, 2024, 14(1): 28281. doi: 10.1038/s41598-024-79283-5.
24.	王智, 伍文浩, 羅子儼, 等. 直腸癌術后回腸造口還納患者發生低位前切除綜合征的影響因素分析 [J]. 陸軍軍醫大學學報, 2025, 47(19): 2405-2413.
25.	Nicotera A, Falletto E, Arezzo A, et al. Risk factors for low anterior resection syndrome (LARS) in patients undergoing laparoscopic surgery for rectal cancer [J]. Surg Endosc, 2022, 36(8): 6059-6066.
26.	任洪波, 劉建, 胡濤, 等. 直腸癌患者術后1年內低位前切除綜合征的變化特征分析及其對患者術后短期生存質量的影響 [J]. 川北醫學院學報, 2020, 35(5): 853-857.
27.	齊嘉晨. 直腸癌術后不同時間低位前切除綜合征的影響因素分析[D]. 合肥: 安徽醫科大學, 2025.
28.	王璋, 邵勝利, 劉鷺, 等. 腹腔鏡直腸癌前切除術后低位前切除綜合征的發生率和癥狀學分析 [J]. 中華胃腸外科雜志, 2024, 27(1): 69-74.
29.	Lauwereins L, D’Hoore A, Coeckelberghs E, et al. A 2-year prospective study on the evolution of low anterior resection syndrome (LARS) following rectal cancer surgery [J/OL]. Int J Colorectal Dis, 2025, 40(1): 220. doi: 10.1007/s00384-025-05009-2.
30.	Huang MJ, Ye L, Yu KX, et al. Development of prediction model of low anterior resection syndrome for colorectal cancer patients after surgery based on machine-learning technique [J]. Cancer Med, 2023, 12(2): 1501-1519.
31.	Brock H, Lambrineas L, Ong HI, et al. Preventative strategies for low anterior resection syndrome [J/OL]. Tech Coloproctol, 2023, 28(1): 10. doi: 10.1007/s10151-023-02872-5.
32.	Varghese C, Wells CI, Bissett IP, et al. The role of colonic motility in low anterior resection syndrome [J/OL]. Front Oncol, 2022, 12: 975386. doi: 10.3389/fonc.2022.975386.
33.	Kim K, An S, Kim MH, et al. High versus low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis [J/OL]. Medicina (Kaunas), 2022, 58(9): 1143. doi: 10.3390/medicina58091143.
34.	Liang Z, Zhang Z, Wu D, et al. Effects of preoperative radiotherapy on long-term bowel function in patients with rectal cancer treated with anterior resection: a systematic review and meta-analysis [J/OL]. Technol Cancer Res Treat, 2022, 21: 15330338221105156. doi: 10.1177/15330338221105156.
35.	Miyo M, Akizuki E, Okuya K, et al. Diagnosis and treatment of low anterior resection syndrome [J]. J Anus Rectum Colon, 2025, 9(1): 1-9.
36.	卜旻淳, 曹先東, 周波. 直腸癌保肛根治術后低位前切除綜合征危險因素分析及列線圖預測模型構建 [J]. 安徽醫科大學學報, 2021, 56(10): 1632-1636.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Shi JF, Wang L, Ran JC, et al. Clinical characteristics, medical service utilization, and expenditure for colorectal cancer in China, 2005 to 2014: overall design and results from a multicenter retrospective epidemiologic survey [J]. Cancer, 2021, 127(11): 1880-1893.
3. Solitano V, Vuyyuru SK, Yuan Y, et al. Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium [J/OL]. Int J Colorectal Dis, 2024, 39(1): 147. doi: 10.1007/s00384-024-04714-8.
4. 李楊, 李心翔, 崔龍, 等. 中國結直腸癌手術病例登記數據庫2025年度報告: 一項全國性前瞻性登記研究 [J]. 中國實用外科雜志, 2026, 46(2): 239-246.
5. Keane C, Fearnhead NS, Bordeianou LG, et al. International consensus definition of low anterior resection syndrome [J]. Dis Colon Rectum, 2020, 63(3): 274-284.
6. 吳曉華, 牛志新, 何峰, 等. 320例老年直腸癌保肛術后低位前切除綜合征的危險因素分析 [J]. 臨床消化病雜志, 2023, 35(4): 316-319.
7. 張蕊, 孫曉林, 張光云, 等. 直腸癌保肛術后低位前切除綜合征發生情況及危險因素分析 [J]. 實用癌癥雜志, 2023, 38(7): 1187-1189, 1193.
8. 張文. 直腸癌保肛根治術后發生低位前切除綜合征的影響因素分析 [J]. 慢性病學雜志, 2026, 27(2): 190-193.
9. Kung VWS, Broad J, Makwana R, et al. The impact of long-course chemoradiotherapy on the myenteric plexus, neuromuscular functions and responses to prokinetic drugs in the human rectum [J]. United European Gastroenterol J, 2024, 12(10): 1417-1428.
10. Benli S, ?olak T, Türkmeno?lu M?. Factors influencing anterior/low anterior resection syndrome after rectal or sigmoid resections [J]. Turk J Med Sci, 2021, 51(2): 623-630.
11. 于瑞璇, 何欣林, 張秋露, 等. 華西DACCA的輔助研究: 單獨的新輔助化療不會影響直腸癌術后近期的肛門功能 [J]. 中國普外基礎與臨床雜志, 2019, 26(5): 595-601.
12. Quezada-Diaz F, Jimenez-Rodriguez RM, Pappou EP, et al. Effect of neoadjuvant systemic chemotherapy with or without chemoradiation on bowel function in rectal cancer patients treated with total mesorectal excision [J]. J Gastrointest Surg, 2019, 23(4): 800-807.
13. Zhang Q, An L, Yu R, et al. The impact of neoadjuvant chemotherapy on low anterior resection syndrome after rectal cancer resection: a 6 months longitudinal follow-up [J]. Asian J Surg, 2021, 44(10): 1260-1265.
14. 黃斌杰, 朱苗苗, 吳雅麗, 等. 低位直腸癌新輔助化療聯合保肛術后發生低位前切除綜合征的現況調查 [J]. 腹部外科, 2023, 36(6): 450-456, 462.
15. 胡海燕, 孫佳男, 張晴, 等. 直腸癌低位前切除綜合征發展軌跡的潛在類別及預測因素分析 [J]. 中國護理管理, 2024, 24(6): 819-824.
16. Al-Rashid F, Robitaille S, Liberman AS, et al. Trajectory of change of low anterior resection syndrome over time after restorative proctectomy for rectal adenocarcinoma [J]. Tech Coloproctol, 2022, 26(3): 195-203.
17. 汪曉東, 曾渝, 李立. 數據庫建設第十部分: 結直腸癌輔助治療的標簽與結構化 [J]. 中國普外基礎與臨床雜志, 2021, 28(8): 1070-1077.
18. 汪曉東, 劉健博, 李立. 數據庫建設第五部分: 結直腸癌的腫瘤特征—模塊的設計(一) [J]. 中國普外基礎與臨床雜志, 2020, 27(3): 345-349.
19. 曹蘭玉, 魏力, 王春梅. 直腸癌前切除綜合征評分量表的漢化及信效度評價 [J]. 中國實用護理雜志, 2013, 29(27): 69-72.
20. Farrokhi K, Marginean H, Al Ghamdi A, et al. The impact of adjuvant chemotherapy on clinical outcomes in locally advanced rectal cancer: a CHORD consortium analysis [J/OL]. Curr Oncol, 2025, 32(7): 371. doi: 10.3390/curroncol32070371.
21. Ye L, Huang M, Huang Y, et al. Risk factors of postoperative low anterior resection syndrome for colorectal cancer: a meta-analysis [J]. Asian J Surg, 2022, 45(1): 39-50.
22. Sun R, Dai Z, Zhang Y, et al. The incidence and risk factors of low anterior resection syndrome (LARS) after sphincter-preserving surgery of rectal cancer: a systematic review and meta-analysis [J]. Support Care Cancer, 2021, 29(12): 7249-7258.
23. Zhang X, Meng Q, Du J, et al. Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient [J/OL]. Sci Rep, 2024, 14(1): 28281. doi: 10.1038/s41598-024-79283-5.
24. 王智, 伍文浩, 羅子儼, 等. 直腸癌術后回腸造口還納患者發生低位前切除綜合征的影響因素分析 [J]. 陸軍軍醫大學學報, 2025, 47(19): 2405-2413.
25. Nicotera A, Falletto E, Arezzo A, et al. Risk factors for low anterior resection syndrome (LARS) in patients undergoing laparoscopic surgery for rectal cancer [J]. Surg Endosc, 2022, 36(8): 6059-6066.
26. 任洪波, 劉建, 胡濤, 等. 直腸癌患者術后1年內低位前切除綜合征的變化特征分析及其對患者術后短期生存質量的影響 [J]. 川北醫學院學報, 2020, 35(5): 853-857.
27. 齊嘉晨. 直腸癌術后不同時間低位前切除綜合征的影響因素分析[D]. 合肥: 安徽醫科大學, 2025.
28. 王璋, 邵勝利, 劉鷺, 等. 腹腔鏡直腸癌前切除術后低位前切除綜合征的發生率和癥狀學分析 [J]. 中華胃腸外科雜志, 2024, 27(1): 69-74.
29. Lauwereins L, D’Hoore A, Coeckelberghs E, et al. A 2-year prospective study on the evolution of low anterior resection syndrome (LARS) following rectal cancer surgery [J/OL]. Int J Colorectal Dis, 2025, 40(1): 220. doi: 10.1007/s00384-025-05009-2.
30. Huang MJ, Ye L, Yu KX, et al. Development of prediction model of low anterior resection syndrome for colorectal cancer patients after surgery based on machine-learning technique [J]. Cancer Med, 2023, 12(2): 1501-1519.
31. Brock H, Lambrineas L, Ong HI, et al. Preventative strategies for low anterior resection syndrome [J/OL]. Tech Coloproctol, 2023, 28(1): 10. doi: 10.1007/s10151-023-02872-5.
32. Varghese C, Wells CI, Bissett IP, et al. The role of colonic motility in low anterior resection syndrome [J/OL]. Front Oncol, 2022, 12: 975386. doi: 10.3389/fonc.2022.975386.
33. Kim K, An S, Kim MH, et al. High versus low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis [J/OL]. Medicina (Kaunas), 2022, 58(9): 1143. doi: 10.3390/medicina58091143.
34. Liang Z, Zhang Z, Wu D, et al. Effects of preoperative radiotherapy on long-term bowel function in patients with rectal cancer treated with anterior resection: a systematic review and meta-analysis [J/OL]. Technol Cancer Res Treat, 2022, 21: 15330338221105156. doi: 10.1177/15330338221105156.
35. Miyo M, Akizuki E, Okuya K, et al. Diagnosis and treatment of low anterior resection syndrome [J]. J Anus Rectum Colon, 2025, 9(1): 1-9.
36. 卜旻淳, 曹先東, 周波. 直腸癌保肛根治術后低位前切除綜合征危險因素分析及列線圖預測模型構建 [J]. 安徽醫科大學學報, 2021, 56(10): 1632-1636.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The impact of adjuvant chemotherapy on the occurrence of low anterior resection syndrome within 6 months after sphincter-preserving surgery for rectal cancer: a study based on the DACCA database

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