Analysis of the relationship between preventive stoma and the incidence and progression of low anorectal resection syndrome following rectal cancer surgery: a retrospective cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Yaolan ¹ , ZHANG Chun ² , LI Yujie ¹ , ZHAO Xinlei ³ , WANG Liya ⁴ , WANG Sutong ⁵ ,  WANG Xiaodong ⁴ ,  HUANG Mingjun ⁶

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 Nursing, Sichuan University / Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. West China School of Nursing, Sichuan University / Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
5. School of Economics, Sichuan University, Chengdu 610044, P. R. China;
6. 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：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn; HUANG Mingjun, Email: huangmingjun@wchscu.cn

Keywords：

rectal cancer; low anterior resection syndrome; preventive stoma; risk of occurrence; developmental trajectory

DOI：

10.7507/1007-9424.202512083

Video：

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Objective To explore the impact of preventive stoma on the occurrence and development trajectory of low anterior resection syndrome (LARS) following rectal cancer surgery. Methods A retrospective cohort study design was employed to collect clinical data from 540 patients who underwent rectal cancer resection at West China Hospital, Sichuan University between April 2018 and June 2022. Patients were categorized into stoma group (n=275) and non-stoma group (n=265) based on the presence or absence of preventive stoma. Generalized estimating equation was used to analyze the impact of stoma-related factors (presence of stoma, stoma type, and interval to stoma closure) on the occurrence of LARS at 1, 3, 6, 9, and 12 months postoperatively. Latent class growth modeling was employed to identify LARS development trajectories, and multi-class logistic regression was used to assess the influence of stoma-related factors on LARS trajectory categories. Results The incidence of LARS showed an overall downward trend within 12 months postoperatively, the incidence rates at 1, 3, 6, 9, and 12 months after operation were 46.3% (250/540), 36.5% (197/540), 27.8% (150/540), 23.0% (124/540) and 16.9% (91/540), respectively. Generalized estimating equation analysis revealed that preventive stoma (OR=1.410, P=0.283), stoma type (OR=1.375, P=0.099), and interval to stoma closure (OR=0.999, P=0.502) were not independent predictors of LARS occurrence. Conversely, at various postoperative time points, educational level (junior college vs. bachelor’s degree or higher: OR=1.834, P=0.039), TNM (stage 2 vs. stage 4: OR=0.533, P=0.016; stage 3 vs. stage 4: OR=0.556, P=0.015), tumor length (OR=1.316, P=0.015), tumor width (OR=0.707, P=0.009), and surgical procedure (ultra-low anterior resection vs. coloanal anastomosis/colon anal anastomosis: OR=2.076, P=0.017) were closely associated with the occurrence of LARS. Latent class growth modeling identified three LARS trajectory categories: low symptom burden–rapid improvement group (286 cases, 53.0%), high symptom burden–slow improvement group (163 cases, 30.2%), and high symptom burden–persistent impairment group (91 cases, 16.8%). Multi-class logistic regression analysis revealed that the presence or absence of preventive stoma was not a predictive factor for LARS trajectory category (high symptom burden–slow improvement group: OR=0.739, P=0.407; high symptom burden–persistent impairment group: OR=0.693, P=0.400). However, patients undergoing ultra-low anterior resection were more likely to be assigned to the high symptom burden-slow improvement group (OR=2.677, P=0.026).Conclusions Preventive stoma is not an independent risk factor for the occurrence or trajectory of LARS. The occurrence of LARS is associated with the tumor’s biological characteristics, surgical approach, and postoperative time, moreover, the surgical approach is a key factor influencing the progression of LARS.

1.	黃理賓, 黃秋實, 楊烈. 全球及中國的結直腸癌流行病學特征及防治: 2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(5): 530-537.
2.	Zhang X, Xu Z, Shang L, et al. Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with predictions to 2046. BMC Cancer, 2025, 25(1): 228. doi: 10.1186/s12885-025-13643-w.
3.	Zhang R, Luo W, Qiu Y, et al. Clinical management of low anterior resection syndrome: review of the current diagnosis and treatment. Cancers (Basel), 2023, 15(20): 5011. doi: 10.3390/cancers15205011.
4.	Keane C, Fearnhead NS, Bordeianou LG, et al. International consensus definition of low anterior resection syndrome. ANZ J Surg, 2020, 90(3): 300-307.
5.	Bolton WS, Chapman SJ, Corrigan N, et al. The incidence of low anterior resection syndrome as assessed in an international randomized controlled trial (MRC/NIHR ROLARR). Ann Surg, 2021, 274(6): e1223-e1229.
6.	Homma Y, Mimura T, Koinuma K, et al. Incidence of low anterior resection syndrome and its association with the quality of life in patients with lower rectal tumors. Surg Today, 2024, 54(8): 857-865.
7.	Luo G, Lu J, Yang Y, et al. Incidence and outcomes of low anterior resection syndrome in patients undergoing preventive ostomy for laparoscopic rectal cancer surgery. Ann Ital Chir, 2025, 96(2): 152-159.
8.	王一琳, 黃明君, 熊方麗, 等. 直腸癌患者術后LARS發生程度對生活質量影響的meta分析. 中國普外基礎與臨床雜志, 2022, 29(2): 179-187.
9.	Ye L, Huang M, Huang Y, et al. Risk factors of postoperative low anterior resection syndrome for colorectal cancer: a meta-analysis. Asian J Surg, 2022, 45(1): 39-50.
10.	Pieniowski EHA, Nordenvall C, Johar A, et al. Defunctioning stoma in rectal cancer surgery - a risk factor for low anterior resection syndrome?. Eur J Surg Oncol, 2022, 48(12): 2518-2524.
11.	Vogel I, Reeves N, Tanis PJ, et al. Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol, 2021, 25(7): 751-760.
12.	Keane C, Park J, ?berg S, et al. Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg, 2019, 106(5): 645-652.
13.	Qi Y, Zhang Z, Yang Q, et al. Analysis of the correlation between defunctioning stoma and postoperative low anterior resection syndrome in rectal cancer: a prospective cohort study. BMC Gastroenterol, 2024, 24(1): 368. doi: 10.1186/s12876-024-03452-z.
14.	Verkuijl SJ, Jonker JE, Furnée EJB, et al. The effect of a temporary stoma on long-term functional outcomes following surgery for rectal cancer. Dis Colon Rectum, 2024, 67(2): 291-301.
15.	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. Tech Coloproctol, 2022, 26(3): 195-203.
16.	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. 中國護理管理, 2024, 24(6): 819-824.
17.	汪曉東, 李立. 數據庫建設第一部分: 個人數據的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(3): 335-342.
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 (二). 中國普外基礎與臨床雜志, 2020, 27(4): 483-488.
19.	國家衛生健康委員會醫政司, 中華醫學會腫瘤學分會. 國家衛健委中國結直腸癌診療規范 (2023版). 中國實用外科雜志, 2023, 43(6): 602-630.
20.	Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg, 2012, 255(5): 922-928.
21.	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. 中國實用護理雜志, 2013, 29(27): 69-72.
22.	羅靜, 江吳邊. 基于潛變量增長曲線模型的老年人抑郁癥狀變化及其影響因素研究. 中國衛生統計, 2022, 39(6): 929-931.
23.	Nguena Nguefack HL, Pagé MG, Katz J, et al. Trajectory modelling techniques useful to epidemiological research: a comparative narrative review of approaches. Clin Epidemiol, 2020, 12: 1205-1222.
24.	Wang X, Zou W, Du Q, et al. Longitudinal trajectories of psychological distress and its influence factors in young and middle-aged patients with colorectal cancer. J Adv Nurs, 2025, 81(7): 3929-3942.
25.	Kolacz J, Tabares JV, Roath OK, et al. Dynamics of PTSD and autonomic symptoms in a longitudinal U. S. population-based sample. Psychol Trauma, 2025. doi: 10.1037/tra0001918.
26.	Xu W, Long X, Xiang Y, et al. Analysis of the trajectory of cognitive function changes and influencing factors in maintenance hemodialysis patients: a prospective longitudinal study. Ren Fail, 2025, 47(1): 2489722. doi: 10.1080/0886022X.2025.2489722.
27.	楊梅, 肖靜, 蔡輝. 多元分析中的多重共線性及其處理方法. 中國衛生統計, 2012, 29(4): 620-624.
28.	Bagley SC, White H, Golomb BA. Logistic regression in the medical literature: standards for use and reporting, with particular attention to one medical domain. J Clin Epidemiol, 2001, 54(10): 979-985.
29.	Helliwell JA, Chilton CH, Young C, et al. Perioperative changes in the microbiome during rectal cancer surgery: exploratory analysis of the National Institute for Health and Care Research (NIHR) IntAct trial. Br J Surg, 2025, 112(9): znaf199. doi: 10.1093/bjs/znaf199.
30.	Rosen H, Sebesta CG, Sebesta C. Management of low anterior resection syndrome (LARS) following resection for rectal cancer. Cancers (Basel), 2023, 15(3): 778. doi: 10.3390/cancers15030778.
31.	Buzatti KCLR, Petroianu A. Pathophysiological aspects of the low anterior resection syndrome for treatment of rectal cancer. Rev Col Bras Cir, 2017, 44(4): 397-402.
32.	Croese AD, Lonie JM, Trollope AF, et al. A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors. Int J Surg, 2018, 56: 234-241.
33.	Zhang X, Meng Q, Du J, et al. Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient. Sci Rep, 2024, 14(1): 28281. doi: 10.1038/s41598-024-79283-5.
34.	Yang S, Tang G, Zhang Y, et al. Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer. Int J Colorectal Dis, 2024, 39(1): 68. doi: 10.1007/s00384-024-04639-2.
35.	Du R, Zhou J, Tong G, et al. Postoperative morbidity and mortality after anterior resection with preventive diverting loop ileostomy versus loop colostomy for rectal cancer: a updated systematic review and meta-analysis. Eur J Surg Oncol, 2021, 47(7): 1514-1525.
36.	Geng HZ, Nasier D, Liu B, et al. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma. Ann R Coll Surg Engl, 2015, 97(7): 494-501.
37.	Chudner A, Gachabayov M, Dyatlov A, et al. The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg, 2019, 404(2): 129-139.
38.	Ahmadi-Amoli H, Rahimi M, Abedi-Kichi R, et al. Early closure compared to late closure of temporary ileostomy in rectal cancer: a randomized controlled trial study. Langenbecks Arch Surg, 2023, 408(1): 234. doi: 10.1007/s00423-023-02934-0.
39.	Dulskas A, Petrauskas V, Kuliavas J, et al. Quality of life and bowel function following early closure of a temporary ileostomy in patients with rectal cancer: a report from a single-center randomized controlled trial. J Clin Med, 2021, 10(4): 768. doi: 10.3390/jcm10040768.
40.	Park J, Danielsen AK, Angenete E, et al. Quality of life in a randomized trial of early closure of temporary ileostomy after rectal resection for cancer (EASY trial). Br J Surg, 2018, 105(3): 244-251.

1. 黃理賓, 黃秋實, 楊烈. 全球及中國的結直腸癌流行病學特征及防治: 2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(5): 530-537.
2. Zhang X, Xu Z, Shang L, et al. Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with predictions to 2046. BMC Cancer, 2025, 25(1): 228. doi: 10.1186/s12885-025-13643-w.
3. Zhang R, Luo W, Qiu Y, et al. Clinical management of low anterior resection syndrome: review of the current diagnosis and treatment. Cancers (Basel), 2023, 15(20): 5011. doi: 10.3390/cancers15205011.
4. Keane C, Fearnhead NS, Bordeianou LG, et al. International consensus definition of low anterior resection syndrome. ANZ J Surg, 2020, 90(3): 300-307.
5. Bolton WS, Chapman SJ, Corrigan N, et al. The incidence of low anterior resection syndrome as assessed in an international randomized controlled trial (MRC/NIHR ROLARR). Ann Surg, 2021, 274(6): e1223-e1229.
6. Homma Y, Mimura T, Koinuma K, et al. Incidence of low anterior resection syndrome and its association with the quality of life in patients with lower rectal tumors. Surg Today, 2024, 54(8): 857-865.
7. Luo G, Lu J, Yang Y, et al. Incidence and outcomes of low anterior resection syndrome in patients undergoing preventive ostomy for laparoscopic rectal cancer surgery. Ann Ital Chir, 2025, 96(2): 152-159.
8. 王一琳, 黃明君, 熊方麗, 等. 直腸癌患者術后LARS發生程度對生活質量影響的meta分析. 中國普外基礎與臨床雜志, 2022, 29(2): 179-187.
9. Ye L, Huang M, Huang Y, et al. Risk factors of postoperative low anterior resection syndrome for colorectal cancer: a meta-analysis. Asian J Surg, 2022, 45(1): 39-50.
10. Pieniowski EHA, Nordenvall C, Johar A, et al. Defunctioning stoma in rectal cancer surgery - a risk factor for low anterior resection syndrome?. Eur J Surg Oncol, 2022, 48(12): 2518-2524.
11. Vogel I, Reeves N, Tanis PJ, et al. Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol, 2021, 25(7): 751-760.
12. Keane C, Park J, ?berg S, et al. Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg, 2019, 106(5): 645-652.
13. Qi Y, Zhang Z, Yang Q, et al. Analysis of the correlation between defunctioning stoma and postoperative low anterior resection syndrome in rectal cancer: a prospective cohort study. BMC Gastroenterol, 2024, 24(1): 368. doi: 10.1186/s12876-024-03452-z.
14. Verkuijl SJ, Jonker JE, Furnée EJB, et al. The effect of a temporary stoma on long-term functional outcomes following surgery for rectal cancer. Dis Colon Rectum, 2024, 67(2): 291-301.
15. 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. Tech Coloproctol, 2022, 26(3): 195-203.
16. 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. 中國護理管理, 2024, 24(6): 819-824.
17. 汪曉東, 李立. 數據庫建設第一部分: 個人數據的標簽與結構化. 中國普外基礎與臨床雜志, 2019, 26(3): 335-342.
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 (二). 中國普外基礎與臨床雜志, 2020, 27(4): 483-488.
19. 國家衛生健康委員會醫政司, 中華醫學會腫瘤學分會. 國家衛健委中國結直腸癌診療規范 (2023版). 中國實用外科雜志, 2023, 43(6): 602-630.
20. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg, 2012, 255(5): 922-928.
21. 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. 中國實用護理雜志, 2013, 29(27): 69-72.
22. 羅靜, 江吳邊. 基于潛變量增長曲線模型的老年人抑郁癥狀變化及其影響因素研究. 中國衛生統計, 2022, 39(6): 929-931.
23. Nguena Nguefack HL, Pagé MG, Katz J, et al. Trajectory modelling techniques useful to epidemiological research: a comparative narrative review of approaches. Clin Epidemiol, 2020, 12: 1205-1222.
24. Wang X, Zou W, Du Q, et al. Longitudinal trajectories of psychological distress and its influence factors in young and middle-aged patients with colorectal cancer. J Adv Nurs, 2025, 81(7): 3929-3942.
25. Kolacz J, Tabares JV, Roath OK, et al. Dynamics of PTSD and autonomic symptoms in a longitudinal U. S. population-based sample. Psychol Trauma, 2025. doi: 10.1037/tra0001918.
26. Xu W, Long X, Xiang Y, et al. Analysis of the trajectory of cognitive function changes and influencing factors in maintenance hemodialysis patients: a prospective longitudinal study. Ren Fail, 2025, 47(1): 2489722. doi: 10.1080/0886022X.2025.2489722.
27. 楊梅, 肖靜, 蔡輝. 多元分析中的多重共線性及其處理方法. 中國衛生統計, 2012, 29(4): 620-624.
28. Bagley SC, White H, Golomb BA. Logistic regression in the medical literature: standards for use and reporting, with particular attention to one medical domain. J Clin Epidemiol, 2001, 54(10): 979-985.
29. Helliwell JA, Chilton CH, Young C, et al. Perioperative changes in the microbiome during rectal cancer surgery: exploratory analysis of the National Institute for Health and Care Research (NIHR) IntAct trial. Br J Surg, 2025, 112(9): znaf199. doi: 10.1093/bjs/znaf199.
30. Rosen H, Sebesta CG, Sebesta C. Management of low anterior resection syndrome (LARS) following resection for rectal cancer. Cancers (Basel), 2023, 15(3): 778. doi: 10.3390/cancers15030778.
31. Buzatti KCLR, Petroianu A. Pathophysiological aspects of the low anterior resection syndrome for treatment of rectal cancer. Rev Col Bras Cir, 2017, 44(4): 397-402.
32. Croese AD, Lonie JM, Trollope AF, et al. A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors. Int J Surg, 2018, 56: 234-241.
33. Zhang X, Meng Q, Du J, et al. Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient. Sci Rep, 2024, 14(1): 28281. doi: 10.1038/s41598-024-79283-5.
34. Yang S, Tang G, Zhang Y, et al. Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer. Int J Colorectal Dis, 2024, 39(1): 68. doi: 10.1007/s00384-024-04639-2.
35. Du R, Zhou J, Tong G, et al. Postoperative morbidity and mortality after anterior resection with preventive diverting loop ileostomy versus loop colostomy for rectal cancer: a updated systematic review and meta-analysis. Eur J Surg Oncol, 2021, 47(7): 1514-1525.
36. Geng HZ, Nasier D, Liu B, et al. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma. Ann R Coll Surg Engl, 2015, 97(7): 494-501.
37. Chudner A, Gachabayov M, Dyatlov A, et al. The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg, 2019, 404(2): 129-139.
38. Ahmadi-Amoli H, Rahimi M, Abedi-Kichi R, et al. Early closure compared to late closure of temporary ileostomy in rectal cancer: a randomized controlled trial study. Langenbecks Arch Surg, 2023, 408(1): 234. doi: 10.1007/s00423-023-02934-0.
39. Dulskas A, Petrauskas V, Kuliavas J, et al. Quality of life and bowel function following early closure of a temporary ileostomy in patients with rectal cancer: a report from a single-center randomized controlled trial. J Clin Med, 2021, 10(4): 768. doi: 10.3390/jcm10040768.
40. Park J, Danielsen AK, Angenete E, et al. Quality of life in a randomized trial of early closure of temporary ileostomy after rectal resection for cancer (EASY trial). Br J Surg, 2018, 105(3): 244-251.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesAnalysis of the relationship between preventive stoma and the incidence and progression of low anorectal resection syndrome following rectal cancer surgery: a retrospective cohort study

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