Original article
Incidence and Characterization of the Anterior Resection Syndrome Through the Use of the LARS Scale (Low Anterior Resection Score)
Incidencia y caracterización del síndrome de resección anterior de recto mediante la utilización de la escala LARS (low anterior resection score)
Alberto Carrillo, José María Enríquez-Navascués
, Araceli Rodríguez, Carlos Placer, José Antonio Múgica, Yolanda Saralegui, Ander Timoteo, Nerea Borda
Corresponding author
Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, San Sebastián, Spain
Read
3873
Timeswas read the article
803
Total PDF
3070
Total HTML
Share statistics
array:24 [ "pii" => "S2173507716000764" "issn" => "21735077" "doi" => "10.1016/j.cireng.2016.02.021" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "1554" "copyright" => "AEC" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Cir Esp. 2016;94:137-43" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1774 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 1349 "PDF" => 416 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0009739X15003139" "issn" => "0009739X" "doi" => "10.1016/j.ciresp.2015.11.005" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "1554" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Cir Esp. 2016;94:137-43" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9109 "formatos" => array:3 [ "EPUB" => 15 "HTML" => 8097 "PDF" => 997 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Incidencia y caracterización del síndrome de resección anterior de recto mediante la utilización de la escala LARS <span class="elsevierStyleItalic">(low anterior resection score)</span>" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "137" "paginaFinal" => "143" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Incidence and characterization of the anterior resection syndrome through the use of the LARS scale (low anterior resection score)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1038 "Ancho" => 1556 "Tamanyo" => 46887 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribución de los pacientes por categoría LARS.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alberto Carrillo, José María Enríquez-Navascués, Araceli Rodríguez, Carlos Placer, José Antonio Múgica, Yolanda Saralegui, Ander Timoteo, Nerea Borda" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Alberto" "apellidos" => "Carrillo" ] 1 => array:2 [ "nombre" => "José María" "apellidos" => "Enríquez-Navascués" ] 2 => array:2 [ "nombre" => "Araceli" "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Placer" ] 4 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Múgica" ] 5 => array:2 [ "nombre" => "Yolanda" "apellidos" => "Saralegui" ] 6 => array:2 [ "nombre" => "Ander" "apellidos" => "Timoteo" ] 7 => array:2 [ "nombre" => "Nerea" "apellidos" => "Borda" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173507716000764" "doi" => "10.1016/j.cireng.2016.02.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507716000764?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X15003139?idApp=UINPBA00004N" "url" => "/0009739X/0000009400000003/v1_201602130044/S0009739X15003139/v1_201602130044/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173507716000752" "issn" => "21735077" "doi" => "10.1016/j.cireng.2016.02.020" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "1549" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Cir Esp. 2016;94:144-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1982 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 1589 "PDF" => 381 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Clinical Results of a New Strategy (Modified CHIVA) for Surgical Treatment of Anterior Accessory Great Saphenous Varicose Veins" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "144" "paginaFinal" => "150" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados clínicos de una nueva estrategia quirúrgica (CHIVA modificado) en el tratamiento de las varices dependientes de la vena safena magna accesoria anterior" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1560 "Ancho" => 950 "Tamanyo" => 194754 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">One-year results after surgery: image showing varicose tributaries of the AASV; the left image shows the preoperative mapping, and situation 12 months after surgery is on the right.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolás Maldonado-Fernández, Jose Patricio Linares-Palomino, Cristina López-Espada, Francisco Javier Martínez-Gámez, Eduardo Ros-Díe" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Maldonado-Fernández" ] 1 => array:2 [ "nombre" => "Jose Patricio" "apellidos" => "Linares-Palomino" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "López-Espada" ] 3 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Martínez-Gámez" ] 4 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Ros-Díe" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X15003085" "doi" => "10.1016/j.ciresp.2015.10.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X15003085?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507716000752?idApp=UINPBA00004N" "url" => "/21735077/0000009400000003/v2_201603270038/S2173507716000752/v2_201603270038/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173507716000673" "issn" => "21735077" "doi" => "10.1016/j.cireng.2016.02.013" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "1466" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Cir Esp. 2016;94:125-36" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5632 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 5197 "PDF" => 426 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Intraoperative Peripheral Nerve Injury in Colorectal Surgery. An Update" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "136" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión intraoperatoria de nervio periférico en cirugía colorrectal. Revisión de conjunto" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1428 "Ancho" => 712 "Tamanyo" => 110436 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Sensitive innervation of the lower limbs. The nerve trunks with injuries mentioned in the literature have been marked. The genitofemoral nerve (genital and upper medial area of the thigh), the obturator nerve (medial thigh), the femoral nerve (anteromedial thigh and calf) and the sciatic nerve (side of calf and foot).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo Colsa Gutiérrez, Raquel Viadero Cervera, Dieter Morales-García, Alfredo Ingelmo Setién" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Pablo" "apellidos" => "Colsa Gutiérrez" ] 1 => array:2 [ "nombre" => "Raquel" "apellidos" => "Viadero Cervera" ] 2 => array:2 [ "nombre" => "Dieter" "apellidos" => "Morales-García" ] 3 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Ingelmo Setién" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X15001050" "doi" => "10.1016/j.ciresp.2015.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X15001050?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507716000673?idApp=UINPBA00004N" "url" => "/21735077/0000009400000003/v2_201603270038/S2173507716000673/v2_201603270038/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Incidence and Characterization of the Anterior Resection Syndrome Through the Use of the LARS Scale (Low Anterior Resection Score)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "137" "paginaFinal" => "143" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alberto Carrillo, José María Enríquez-Navascués, Araceli Rodríguez, Carlos Placer, José Antonio Múgica, Yolanda Saralegui, Ander Timoteo, Nerea Borda" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Alberto" "apellidos" => "Carrillo" ] 1 => array:4 [ "nombre" => "José María" "apellidos" => "Enríquez-Navascués" "email" => array:1 [ 0 => "josemaria.enriqueznavascues@osakidetza.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Araceli" "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Placer" ] 4 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Múgica" ] 5 => array:2 [ "nombre" => "Yolanda" "apellidos" => "Saralegui" ] 6 => array:2 [ "nombre" => "Ander" "apellidos" => "Timoteo" ] 7 => array:2 [ "nombre" => "Nerea" "apellidos" => "Borda" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, San Sebastián, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia y caracterización del síndrome de resección anterior de recto mediante la utilización de la escala LARS (<span class="elsevierStyleItalic">low anterior resection score</span>)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1038 "Ancho" => 1555 "Tamanyo" => 46782 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of the patients according to LARS category.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In the last 3 decades advances in rectal cancer treatment have achieved a reduction in the locoregional recurrence rate. Additionally, they have made it possible to centre the therapeutic objective on the preservation of the sphincter function (and even the organ itself) while maintaining overall survival and disease-free rates. These largely and finally depend on the current or future existence of systemic disease. Anterior resection of the rectum while preserving intestinal continuity using various types of colorectal or colo-anal anastomosis, with or without combined radiochemotherapy, is today the most frequent treatment for cancer of the rectum.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Most of the patients operated with preservation of the sphincter will develop an alteration of intestinal and defecatory functions. The dysfunction varies in its symptoms and severity, and it manifests as urgency, incontinence and fragmented defecation, with bowel movements that are repeated, incomplete or difficult. The set of these symptoms constitutes what is known as the anterior resection syndrome (ARS), which may have a negative effect on the lives of operated patients. It is at present one of the main topics for clinical research.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the heterogeneous nature of the physiopathological, clinical and therapeutic aspects in connection with ARS, evaluation of the same has been predominantly descriptive and not quantitative, using unvalidated questionnaires. This has prevented comparative analyses of the functional results of different therapeutic approaches.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Recently an international scoring system, the “LARS scale”, has been prepared, translated and validated in several languages. This makes it possible to quantify the severity of intestinal and defecatory dysfunction in a simple way, facilitating comparison and meta-analysis of different aspects of treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> This scoring system has also been correlated with quality of life in an international study by applying the EORTC QLQ-C30 questionnaire for patients operated for cancer, and a relationship between quality of life and patients’ LARS has been observed.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study is to study the incidence, distribution and severity of ARS among our rectal cancer patients treated by anterior resection using the LARS score. It aims to confirm its quantitative correlation with the risk factors (clinical, therapeutic or pathological) which are known to be connected with ARS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">All of the patients treated in our hospital for rectal cancer with a curative purpose by anterior resection of the rectum from October 2007 to February 2014 were included in this study. Patient data recorded in the hospital rectal cancer record were used prospectively and consecutively. In turn these were included (and are available) in the national record of Proyecto Vikingo.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with intersphincteric or associated multivisceral resection were excluded, as were those who had not had a reconstructed transit for at least one year. One year was taken to mean one year after the operation if they did not have a derivative stoma, or one year after the closure of the stoma. No age restrictions were applied.</p><p id="par0035" class="elsevierStylePara elsevierViewall">All of the patients were sent a letter by ordinary mail which contained, together with the request to take part in the study, an informative note describing its aim and a declaration of its confidentiality. It also contained the LARS scale questionnaire in Spanish and a question that had been used in previous LARS validation studies about their opinion of how their intestinal and defecatory symptoms affected their overall quality of daily life. The patients who failed to answer the questionnaire appropriately were excluded.</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the LARS questionnaire, which is composed of 5 questions that centre on the symptoms experienced by patients; the sum of all the items varies from 0 to 42 points, for classification into 3 groups: non-LARS (0–20 points), minor LARS (21–29 points) and major LARS (30–42 points). The question about quality of life was “In general, how much does the functioning of your intestines affect your quality of life?” There were 4 possible options: “not at all”, “very little” “quite a lot” or “a lot”. The variables selected to study possible risk factors for ARS and its correlation with the LARS were age, sex, length of time after surgery (or after closure of the protective stoma), the type of resection performed (high or low), the extent of the mesorectal resection (total or partial), the surgical approach used (open, laparoscopic or converted), type of anastomosis (colorectal or colo-anal; manual or mechanical), the use of a colonic reservoir or transverse coloplasty or not (lateroterminal or terminoterminal anastomosis), the creation of a derivative stoma (yes or no), postoperative complication of the anastomosis (dehiscence or abscess, yes or no) and the radiotherapy regime (no radiotherapy, short or long).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">All of the patients had been evaluated by the Multidisciplinary Colorectal Cancer Committee. High resolution NMR was used to stage the cancer before operating and to evaluate mesorectal involvement and the height, length and lower edge of the tumour. In general, total mesorectal resection was used for cancer of the mid to low rectum, while partial mesorectal resection was used for upper rectal cancer. When this was considered to be indicated, and following discussion in the Multidisciplinary Committee, 2 neoadjuvant treatment regimes were used. These consisted of long chemoradiotherapy (54<span class="elsevierStyleHsp" style=""></span>Gy in 5 weeks with chemotherapy at the start and end of radiotherapy) or short radiotherapy (25<span class="elsevierStyleHsp" style=""></span>Gy over 5 days). The anastomosis was only examined using imaging techniques if there was the clinical suspicion of a complication.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical Analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">The results were analysed in the Clinical Epidemiological Department of the hospital using the STATA program (StataCorp. 2013. StataStatistical Software: Release 13. College Station, TX: StataCorp LP).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Data are described in terms of absolute and relative frequencies in percentages and averages with standard deviation for continual variables, or the median and interquartile range if the data distribution made this advisable.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Firstly possible risk factors with the LARS category were analysed in univariate analysis. This had the purpose of identifying statistically significant variables using the Student <span class="elsevierStyleItalic">t</span>-test (Mann–Whitney <span class="elsevierStyleItalic">U</span> test) or Pearson's <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> (Fisher's test). Multivariate logistical regression test analysis was then used to identify significant risk factors (<span class="elsevierStyleItalic">P</span><.05) independently associated with a major LARS.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The Student <span class="elsevierStyleItalic">t</span>-test (and the Mann–Whitney <span class="elsevierStyleItalic">U</span> test) were used to study the correlation between the LARS and quality of life, after grouping the categories “not at all” and “very little” on the one hand, and “quite a lot” and “a lot” on the other, to increase the power of the study.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">402 patients were operated on for cancer of the rectum from October 2007 to February 2014 in our hospital. Of these, 260 (65%) had an anterior resection of the rectum. 65 patients were excluded because they still had an unclosed ileostomy or because less than one year had passed since their surgery at the time of carrying out the survey. 195 patients were contacted by ordinary mail. A total of 136 patients (70%) answered the questionnaire, 132 of whom did so appropriately. 4 questionnaires were invalidated due to formal defects, as several answers had been selected simultaneously. The study sample was therefore composed of these 132 patients.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The median patient age was 68 years old, with a range from 45 to 90 years old. The median time which had passed from surgery to the survey was 37 months. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the demographic, clinical and therapeutic characteristics of the patients studied.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the distribution of the patients in the different LARS categories. As may be seen, 62 patients (47%) presented a major LARS.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the correlation between the LARS and the answer to the question on the effect of intestinal and defecatory symptoms on quality of life. A good correlation can be seen between a high LARS and greater effect on quality of life. Nevertheless, only when we group the categories “not at all” and “very little” on the one hand, and “quite a lot” and “a lot” on the other do we find significant differences between the 2 groups respecting LARS. No differences were found when the “not at all” and “very little” groups were compared, or when “quite a lot” was compared with “a lot”.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">To study the correlation between the LARS and the selected variables, some of the latter were grouped as they lacked a sufficient number of patients. The following variables were grouped: the surgical approach (laparoscopy vs open plus converted), the construction of a reservoir (a colonic J-pouch plus coloplasty vs L-T anastomosis) and the administration of radiotherapy (yes vs no). Univariate analysis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) showed statistically significant differences for technique type and the mesorectal exeresis used (<span class="elsevierStyleItalic">P</span><.001), the use of a reservoir or coloplasty (<span class="elsevierStyleItalic">P</span>=.017), the creation of a derivative stoma (<span class="elsevierStyleItalic">P</span>=.003) and the use of a long preoperative period of radiotherapy (<span class="elsevierStyleItalic">P</span>=.019).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The significant variables for univariate analysis were included in the logistic regression model of the multivariate analysis. Only the type of technique and mesorectal exeresis used (<span class="elsevierStyleItalic">P</span><.001), and the use of a reservoir or coloplasty (<span class="elsevierStyleItalic">P</span>=.002) are independently statistically significant for LARS.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">In this study, half of the patients operated on for cancer of the rectum using low resection presented a major LARS, and only one-third had no quantifiable ARS. The overall perception of quality of life was significantly worse in patients with a major LARS. Total mesorectal resection and the form of reconstruction of the colorectal anastomosis were the main factors associated with the LARS.</p><p id="par0105" class="elsevierStylePara elsevierViewall">These data agree with and reproduce those already published to validate the LARS scale in international studies.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> The response rate in this study was 70%, and although it would be desirable to have a higher rate of valid responses, this datum together with the previous one suggests that the causes studied are representative of the population of patients treated using anterior resection of the rectum. Moreover, as other studies have pointed out,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> the non-responders are often those whose functional results are the most extreme, thereby improving the balance.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The correlation found between the ARS quantification and the question of impact on quality of life reflects the importance of intestinal/defecatory dysfunction. Although quality of life is determined by many factors (physical, emotional, social and cognitive, etc.) and while the LARS does not ask about other aspects such as sexual or urinary dysfunction, a recent study demonstrated the importance of the ARS, quantified by LARS, in how patients perceive their quality of life as measured by the EORTC QLQ-C30.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Although the functional alterations of the ARS are more intense and apparent in the first 12 months after surgery, after which the symptoms stabilise, the long-term results indicate that the ARS is a permanent alteration with a multifactor physiopathology.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The ARS has a wide range of symptoms; however, they can be divided into 2 types: those connected with continence (2 LARS questions) and defecatory alterations (3 LARS questions). It is interesting to observe that the surgeons and patients assess these symptoms differently: while surgeons tend to overestimate the aspects in connection with continence and to underestimate those relating to defecatory dysfunction, the patients attribute contrasting degrees of importance to these factors.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In connection with the alteration of continence, it has been said that the reduction of sphincter tone that is often observed after an anterior resection, is due more to injury to the intra- and extramural nervous plexus than because of the complete mobilisation of the rectum, that it is to structural damage to the sphincter.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">On the other hand, defecatory dysfunction (fragmentation and frequency) is connected to the reduction in volume and compliance of the colon compared to the rectum, with the loss of anorectal coordination and sensitivity, and with the alteration in colonic motility.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The latter has chiefly been observed following rectal resection, although less intensely; it may also occur following a sigmoidectomy.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">As could be expected, the LARS score was higher in cases of low anterior resection with total mesorectal excision than it was in cases of partial or subtotal excision. This aspect in turn reflects the height of the rectal tumour and the need to perform a total or subtotal proctectomy, together with the functional implication of the absence of all or part of the rectum.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Other aspects that may affect the severity of the ARS are the way the colorectal anastomosis is reconstructed, the absence of complications and the administration of pelvic radiation. We found a correlation between the creation of some type of colonic reservoir and the LARS. This coincides with known aspects relating to the functional superiority of reservoirs over terminoterminal anastomosis, while also highlighting the capacity of the LARS to discriminate these results.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Unlike the LARS scale validation studies, we found no clear indication of the role of radiotherapy in the quantification of the ARS using the LARS. The limited number of cases in our study for this factor is clearly a restriction here. Additionally, the tendency towards a minor LARS in patients treated with short radiotherapy may be due to the fact that this is used more in upper rectal tumours.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Many authors have pointed out the pernicious effects of radiotherapy on intestinal functioning after anterior resection. Nevertheless, if radiotherapy had a relevant role in the development of the ARS, the intestinal dysfunction could be expected to increase over time rather than stabilising. Other authors have stated that the impact of radiotherapy on quality of life and urogenital functioning is less than expected, although the studies in question followed abdominoperineal resection.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> In any case, current radiotherapy techniques and regimes are able to restrict harm in comparison with older therapies.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">To conclude, almost half of the patients operated for cancer of the rectumby anterior resection present an ARS quantified as “major” on the LARS scale, which affects their quality of life. Complete proctectomy with total mesorectal excision is the most important independent risk factor for a major LARS. The LARS scale, validated in Spanish, is a simple and quick means of quantifying the ARS and comparing the functional results of different therapeutic or reconstructive strategies following rectal resection. It may also be useful in evaluating the duration of the efficacy of different treatments which have the aim of relieving or improving the ARS.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Authorship/Collaborators</span><p id="par0160" class="elsevierStylePara elsevierViewall">Study conception and design: Alberto Carrillo.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Critical revision of the manuscript and contribution to its contents: José María Enriquez-Navascués.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Data gathering and processing: Araceli Rodríguez, Ander Timoteo and Nerea Borda.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Statistical analysis and interpretation: Carlos Placer and José Andrés Múgica.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Draft manuscript: Alberto Carrillo and Yolanda Saralegui.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Revision and approval of the manuscript: all of the authors.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of Interests</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres621283" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec635532" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres621284" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec635533" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Authorship/Collaborators" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-09-02" "fechaAceptado" => "2015-11-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec635532" "palabras" => array:5 [ 0 => "Rectal neoplasm" 1 => "Anterior resection of rectum" 2 => "Anterior resection syndrome" 3 => "LARS scale" 4 => "Functional results" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec635533" "palabras" => array:5 [ 0 => "Neoplasia rectal" 1 => "Resección anterior de recto" 2 => "Síndrome de resección anterior" 3 => "Escala LARS" 4 => "Resultados funcionales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recently a score (LARS) has been internationally validated that quantifies the anterior resection syndrome (ARS). The objective of this study is to know the incidence and severity of the ARS using LARS and its correlation with selected variables or risk factors.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All operated patients with anterior resection for rectal cancer between October 2007 and February 2014, with curative intention and at least one year of functionality, were sent a LARS questionnaire. The variables studied were age sex, time elapsed since surgery, type of surgical approach, type of anastomosis, derivative ileostomy, postoperative pelvic complication, and radiotherapy regimen.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Out of 195 patients, 136 (70%) responded, and 132 responded properly. A total of 47% of the patients presented “severe” LARS and 34% did not develop quantifiable ARS. Quality of life was worse in the highest LARS scores (<span class="elsevierStyleItalic">P</span>=.002). In the univariate analysis, total mesorectal excision, long radiotherapy regimen and derivative stoma were associated to “severe” LARS and the use of a reservoir was associated with minor LARS. In multivariate analysis only the type of resection (<span class="elsevierStyleItalic">P</span><.001) and the use of a reservoir (<span class="elsevierStyleItalic">P</span>=.002) were individual factors related to LARS.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Half of the operated patients presented high LARS score and only a third did not provide a quantifiable ARS. The overall perception of quality of life was significantly worse in patients with more severe LARS. The absence of the rectum (total mesorectal excision) and the type of anastomosis were the main factors associated with the LARS score.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recientemente se ha validado una escala internacional de puntuación (LARS) que cuantifica el síndrome de resección anterior (SRA). El objetivo de este estudio es conocer la incidencia y gravedad del SRA utilizando el LARS y su relación con variables seleccionadas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A todos los pacientes con resección anterior por cáncer de recto operados entre octubre de 2007 y febrero de 2014, con intención curativa y con más de un año de funcionalidad, se les envió el cuestionario LARS. Las variables estudiadas fueron: edad, sexo, tiempo transcurrido desde la cirugía, tipo de resección, vía quirúrgica, tipo de anastomosis, realización de estoma derivativo, complicación postoperatoria y régimen de radioterapia.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De 195 pacientes, 136 (70%) respondieron (132 adecuadamente). El 47% de los pacientes presentaba un LARS mayor y el 34% no desarrolló SRA cuantificable. Se relacionó un LARS mayor con peor calidad de vida (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002). En el análisis univariante, la escisión mesorrectal total (ETM), la radioterapia larga y el estoma derivativo se asociaron a un LARS mayor, y la utilización de un reservorio, a uno menor. En el análisis multivariante solo el tipo de resección (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) y la utilización de reservorio (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002) fueron factores individuales relacionados con el LARS.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La mitad de los pacientes operados presentaron un LARS mayor y solo un tercio no presentó un SRA cuantificable. La percepción global de la calidad de vida fue significativamente peor en los pacientes con LARS mayor. La ausencia de recto (ETM) y la forma de reconstrucción anastomótica fueron los principales factores asociados a la puntuación LARS.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Carrillo A, Enríquez-Navascués JM, Rodríguez A, Placer C, Múgica JA, Saralegui Y, et al. Incidencia y caracterización del síndrome de resección anterior de recto mediante la utilización de la escala LARS (<span class="elsevierStyleItalic">low anterior resection score</span>). Cir Esp. 2016;94:137–143.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1038 "Ancho" => 1555 "Tamanyo" => 46782 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of the patients according to LARS category.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1572 "Ancho" => 2173 "Tamanyo" => 82272 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of the LARS in the different quality-of-life categories. Major LARS grouping the categories “quite a lot”+“a lot”, as opposed to “not at all”+“very little”, <span class="elsevierStyleItalic">P</span><.001.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">0–20: no LARS; 21–29: Minor LARS; 30–42: Major LARS.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Points \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Do you ever have occasions when you cannot control flatus (winds)?</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No, never \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, less than once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, at least once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Do you ever have any accidental leakage of liquid stool?</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No, never \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, less than once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, at least once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">How often do you open your bowels?</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>More than 7 times per day (24<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4–7 times per day (24<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1–3 times per day (24<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Less than once per day (24<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Do you ever have to open your bowels again within one hour of the last bowel opening?</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No, never \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, less than once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, at least once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Do you ever have such a strong urge to open your bowels that you have to rush to the toilet?</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No, never \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, less than once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes, at least once per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1018702.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">LARS Questionnaire in Spanish.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">PMR: partial mesorectal resection; TMR: total mesorectal resection; rt: radiotherapy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">No.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">132 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Men, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (68.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age at surgery (median and range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68 (45–90) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time since surgery (median)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Technique, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anterior resection with PMR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (26.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anterior resection with TMR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 (73.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Surgical approach, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Laparoscopic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">105 (79.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Open \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (10.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Primary anastomosis, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mechanical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">119 (90.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Reservoir, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coloplasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>J-pouch colonic reservoir \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lateroterminal anastomosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">111 (83.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Derivative stoma n, (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 (44.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 (55.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Complication of anastomosis, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (2.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">129 (97.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Radiotherapy, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65 (49.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 (50.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Short rt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (14.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Long rt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1018701.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The Demographic, Clinical and Therapeutic Characteristics of the Patients.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">PMR: partial mesorectal resection; TMR: total mesorectal resection; LAR: low anterior resection; rt: radiotherapy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LARS category</th><th class="td" title="table-head " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Minor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Grouped \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Major \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age (average, years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time after surgery (average, months)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Technique</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LAR+PMR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LAR+TMR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Surgical approach</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Laparoscopic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Open \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Grouped surgical approach</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.297 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Laparoscopic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Open+conversion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anastomosis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.657 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mechanical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Reservoir</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coloplasty or J-pouch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span> L-T anastomosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Derivative stoma</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Complication of anastomosis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.641 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Radiotherapy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Short rt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Long rt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Grouped radiotherapy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.097 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Long rt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1018703.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Univariate Analysis. LARS vs Study Variables.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anterior resection syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.L. Bryant" 1 => "P.J. Lunniss" 2 => "C.H. Knowles" 3 => "M.A. Thaha" 4 => "C.L. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(12)70236-X" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "e403" "paginaFinal" => "e4088" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22935240" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.J. Emmertsen" 1 => "S. Laurberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e31824f1c21" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2012" "volumen" => "255" "paginaInicial" => "922" "paginaFinal" => "928" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22504191" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International validation of the low anterior resection syndrome score" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Juul" 1 => "M. Ahlberg" 2 => "S. Biondo" 3 => "K.J. Emmertsen" 4 => "E. Espin" 5 => "L.M. Jimenez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e31828fac0b" "Revista" => array:7 [ "tituloSerie" => "Ann Surg" "fecha" => "2014" "volumen" => "259" "paginaInicial" => "728" "paginaFinal" => "734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23598379" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1935861X09000333" "estado" => "S300" "issn" => "1935861X" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low anterior resection syndrome and quality of life: an international multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Juul" 1 => "M. Ahlberg" 2 => "S. Biondo" 3 => "E. Espin" 4 => "L.M. Jimenez" 5 => "K.E. Matzel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DCR.0000000000000116" "Revista" => array:6 [ "tituloSerie" => "Dis Colon Rectum" "fecha" => "2014" "volumen" => "57" "paginaInicial" => "585" "paginaFinal" => "591" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24819098" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Proyecto Vikingo de la Asociación Española de Cirugía. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.aecirujanos.es/secciones/coloproctologia/proyecto_vikingo.php">http://www.aecirujanos.es/secciones/coloproctologia/proyecto_vikingo.php</a> [accessed 02.09.15]." ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bowel dysfunction after rectal cancer treatment: a study comparing the specialist's versus patient's perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Yen-Ting" 1 => "K.J. Emmertsen" 2 => "S. Lauberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjopen-2013-003374" "Revista" => array:5 [ "tituloSerie" => "BMJ Open" "fecha" => "2013" "volumen" => "4" "paginaInicial" => "e003374" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24448844" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sigmoidectomy syndrome? Patient's perspectives on the functional outcomes following surgery for diverticulitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Levack" 1 => "L.R. Savitt" 2 => "D.L. Berger" 3 => "P.C. Shellito" 4 => "R.A. Hodin" 5 => "D.W. Rattner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DCR.0b013e31823907a9" "Revista" => array:6 [ "tituloSerie" => "Dis Colon Rectum" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "10" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22156862" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long term quality of life and sexual and urinary function after abdominoperineal resection for distal rectal cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.S. Kasparek" 1 => "I. Hassan" 2 => "R.R. Cima" 3 => "D.R. Larson" 4 => "R.E. Gullerud" 5 => "B.G. Wolff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DCR.0b013e31823d2606" "Revista" => array:6 [ "tituloSerie" => "Dis Colon Rectum" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "147" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22228157" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.J. Stephens" 1 => "L.C. Thompson" 2 => "P. Quirke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2009.26.5264" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "4233" "paginaFinal" => "4239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20585099" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009400000003/v2_201603270038/S2173507716000764/v2_201603270038/en/main.assets" "Apartado" => array:4 [ "identificador" => "7417" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009400000003/v2_201603270038/S2173507716000764/v2_201603270038/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507716000764?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 0 | 8 |
| 2024 October | 19 | 2 | 21 |
| 2024 September | 22 | 6 | 28 |
| 2024 August | 21 | 5 | 26 |
| 2024 July | 17 | 5 | 22 |
| 2024 June | 19 | 5 | 24 |
| 2024 May | 10 | 5 | 15 |
| 2024 April | 16 | 4 | 20 |
| 2024 March | 26 | 2 | 28 |
| 2024 February | 12 | 3 | 15 |
| 2024 January | 22 | 3 | 25 |
| 2023 December | 27 | 0 | 27 |
| 2023 November | 27 | 8 | 35 |
| 2023 October | 17 | 3 | 20 |
| 2023 September | 16 | 2 | 18 |
| 2023 August | 16 | 3 | 19 |
| 2023 July | 15 | 7 | 22 |
| 2023 June | 27 | 2 | 29 |
| 2023 May | 72 | 3 | 75 |
| 2023 April | 74 | 0 | 74 |
| 2023 March | 39 | 4 | 43 |
| 2023 February | 22 | 3 | 25 |
| 2023 January | 26 | 6 | 32 |
| 2022 December | 17 | 2 | 19 |
| 2022 November | 16 | 4 | 20 |
| 2022 October | 21 | 9 | 30 |
| 2022 September | 16 | 19 | 35 |
| 2022 August | 26 | 17 | 43 |
| 2022 July | 10 | 7 | 17 |
| 2022 June | 17 | 5 | 22 |
| 2022 May | 37 | 10 | 47 |
| 2022 April | 25 | 4 | 29 |
| 2022 March | 15 | 7 | 22 |
| 2022 February | 20 | 7 | 27 |
| 2022 January | 34 | 8 | 42 |
| 2021 December | 25 | 10 | 35 |
| 2021 November | 30 | 7 | 37 |
| 2021 October | 37 | 9 | 46 |
| 2021 September | 27 | 10 | 37 |
| 2021 August | 37 | 5 | 42 |
| 2021 July | 31 | 9 | 40 |
| 2021 June | 34 | 8 | 42 |
| 2021 May | 42 | 9 | 51 |
| 2021 April | 91 | 13 | 104 |
| 2021 March | 59 | 8 | 67 |
| 2021 February | 38 | 7 | 45 |
| 2021 January | 46 | 10 | 56 |
| 2020 December | 35 | 10 | 45 |
| 2020 November | 49 | 17 | 66 |
| 2020 October | 23 | 4 | 27 |
| 2020 September | 38 | 13 | 51 |
| 2020 August | 53 | 8 | 61 |
| 2020 July | 52 | 14 | 66 |
| 2020 June | 39 | 14 | 53 |
| 2020 May | 35 | 10 | 45 |
| 2020 April | 22 | 4 | 26 |
| 2020 March | 38 | 4 | 42 |
| 2020 February | 38 | 10 | 48 |
| 2020 January | 42 | 12 | 54 |
| 2019 December | 63 | 14 | 77 |
| 2019 November | 37 | 9 | 46 |
| 2019 October | 36 | 3 | 39 |
| 2019 September | 35 | 10 | 45 |
| 2019 August | 33 | 1 | 34 |
| 2019 July | 37 | 18 | 55 |
| 2019 June | 65 | 20 | 85 |
| 2019 May | 161 | 46 | 207 |
| 2019 April | 65 | 13 | 78 |
| 2019 March | 31 | 9 | 40 |
| 2019 February | 35 | 8 | 43 |
| 2019 January | 25 | 3 | 28 |
| 2018 December | 23 | 3 | 26 |
| 2018 November | 34 | 12 | 46 |
| 2018 October | 29 | 9 | 38 |
| 2018 September | 28 | 6 | 34 |
| 2018 August | 12 | 9 | 21 |
| 2018 July | 9 | 0 | 9 |
| 2018 June | 13 | 1 | 14 |
| 2018 May | 19 | 1 | 20 |
| 2018 April | 29 | 2 | 31 |
| 2018 March | 26 | 2 | 28 |
| 2018 February | 13 | 2 | 15 |
| 2018 January | 11 | 1 | 12 |
| 2017 December | 17 | 0 | 17 |
| 2017 November | 14 | 5 | 19 |
| 2017 October | 27 | 1 | 28 |
| 2017 September | 16 | 1 | 17 |
| 2017 August | 12 | 1 | 13 |
| 2017 July | 10 | 5 | 15 |
| 2017 June | 21 | 1 | 22 |
| 2017 May | 32 | 6 | 38 |
| 2017 April | 17 | 10 | 27 |
| 2017 March | 21 | 31 | 52 |
| 2017 February | 18 | 5 | 23 |
| 2017 January | 18 | 12 | 30 |
| 2016 December | 18 | 15 | 33 |
| 2016 November | 21 | 15 | 36 |
| 2016 October | 32 | 28 | 60 |
| 2016 September | 37 | 19 | 56 |
| 2016 August | 36 | 12 | 48 |
| 2016 July | 30 | 15 | 45 |
| 2016 June | 17 | 14 | 31 |
| 2016 April | 2 | 0 | 2 |
Show all
