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Karam E, Fredon F, Eid Y, Muller O, Besson M, Michot N, Giger-Pabst U, Alves A, Ouaissi M. Review of definition and treatment of upper rectal cancer. Surg Oncol 2024; 57:102145. [PMID: 39342742 DOI: 10.1016/j.suronc.2024.102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/14/2024] [Accepted: 09/19/2024] [Indexed: 10/01/2024]
Abstract
While the treatment of locally advanced lower and middle rectal cancer with total mesorectal excision (TME) after neoadjuvant therapy is now well defined, the treatment of locally advanced upper rectal cancer (LAURC) remains controversial. Although most teams and academic societies recommend upfront surgery (US) with partial mesorectal excision (PME), as this appears to be sufficient for these tumors, the literature remains conflicting regarding the additional use of neoadjuvant therapy and TME. Current recommendations for the treatment of LAURC do not reflect actual clinical practice. Notably, there is a paucity of published data specific to the treatment of LAURC since most of the data are from sub-analyses of different cohorts. Another important point responsible for the inconsistent data situation is the fact that the current definition of upper rectal cancer is based on anatomical criteria that are difficult to reproduce and therefore also differ between international professional societies. The aim of this review is to provide a deeper insight into the issues surrounding the treatment of LAURC based on an analysis of the current literature, including anatomic and embryologic data.
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Affiliation(s)
- Elias Karam
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, France
| | - Fabien Fredon
- Department of Digestive Surgery, Dupuytren Hospital, University Hospital of Limoges, France
| | - Yassine Eid
- Department of Digestive Surgery, Caen Hospital, University Hospital of Caen, France
| | - Olivier Muller
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, France
| | - Marie Besson
- Department of Radiology, Trousseau Hospital, University Hospital of Tours, France
| | - Nicolas Michot
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, France
| | - Urs Giger-Pabst
- Fliedner Fachhochschule, University of Applied Sciences, Düsseldorf, Germany
| | - Arnaud Alves
- Fliedner Fachhochschule, University of Applied Sciences, Düsseldorf, Germany
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, France.
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Zhou L, Zhong C, Su Y, Zhang Z, Wang L. Application of pelvic floor rehabilitation in patients with colorectal cancer: a scoping review. Tech Coloproctol 2024; 28:141. [PMID: 39373909 DOI: 10.1007/s10151-024-03017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/30/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Pelvic floor rehabilitation is common in patients with colorectal cancer, the purpose of this study is to analyze the role of pelvic floor rehabilitation in patients with colorectal cancer and to understand the specific details of pelvic floor rehabilitation intervention in patients with colorectal cancer. METHODS Six databases were searched for this scoping review and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. RESULTS A total of 1014 studies were searched, and 12 studies were finally included for analysis. The study found that pelvic floor rehabilitation for colorectal cancer patients can help improve bowel symptoms, quality of life, and psychological status of colorectal cancer patients after surgery, but details of the interventions for pelvic floor rehabilitation for colorectal cancer patients are not standardized. CONCLUSIONS Pelvic floor rehabilitation has shown positive significance in patients with colorectal cancer, but there is a lack of uniform standards in the process of pelvic floor rehabilitation intervention in patients with colorectal cancer.
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Affiliation(s)
- Lu Zhou
- Department of Nursing, Peking University People's Hospital, Beijing, People's Republic of China
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Changkun Zhong
- Gastrointestinal Surgery, People's Hospital of Peking University, Beijing, People's Republic of China
| | - Yuanyuan Su
- Gastrointestinal Surgery, People's Hospital of Peking University, Beijing, People's Republic of China
| | - Zhengyang Zhang
- Department of Nursing, Peking University People's Hospital, Beijing, People's Republic of China
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Ling Wang
- Department of Nursing, Peking University People's Hospital, Beijing, People's Republic of China.
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Cao G, Zhang X, Wang F, Man D, Wu L, Pan X, Chen S. Biofeedback combined with percutaneous electrical pudendal nerve stimulation for the treatment of low anterior rectal resection syndrome: a study protocol for a randomized controlled trial. Trials 2024; 25:440. [PMID: 38956630 PMCID: PMC11221096 DOI: 10.1186/s13063-024-08300-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Low anterior resection syndrome (LARS) is a distressing condition that affects approximately 25-80% of patients following surgery for rectal cancer. LARS is characterized by debilitating bowel dysfunction symptoms, including fecal incontinence, urgent bowel movements, and increased frequency of bowel movements. Although biofeedback therapy has demonstrated effectiveness in improving postoperative rectal control, the research results have not fulfilled expectations. Recent research has highlighted that stimulating the pudendal perineal nerves has a superior impact on enhancing pelvic floor muscle function than biofeedback alone. Hence, this study aims to evaluate the efficacy of a combined approach integrating biofeedback with percutaneous electrical pudendal nerve stimulation (B-PEPNS) in patients with LARS through a randomized controlled trial (RCT). METHODS AND ANALYSIS In this two-armed multicenter RCT, 242 participants with LARS after rectal surgery will be randomly assigned to undergo B-PEPNS (intervention group) or biofeedback (control group). Over 4 weeks, each participant will undergo 20 treatment sessions. The primary outcome will be the LARS score. The secondary outcomes will be anorectal manometry and pelvic floor muscle electromyography findings and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal 29 (EORTC QLQ-CR29) scores. Data will be collected at baseline, post-intervention (1 month), and follow-up (6 months). DISCUSSION We anticipate that this study will contribute further evidence regarding the efficacy of B-PEPNS in alleviating LARS symptoms and enhancing the quality of life for patients following rectal cancer surgery. TRIAL REGISTRATION Chinese Clincal Trials Register ChiCTR2300078101. Registered 28 November 2023.
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Affiliation(s)
- Gaoyang Cao
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Xinjie Zhang
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Fei Wang
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Da Man
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Lijie Wu
- Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310000, Zhejiang, China
| | - Xuchu Pan
- Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310000, Zhejiang, China
| | - Shan Chen
- Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310000, Zhejiang, China.
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de Miguel Valencia MJ, Marin G, Acevedo A, Hernando A, Álvarez A, Oteiza F, de Miguel Velasco MJ. Long-term outcomes of sacral neuromodulation for low anterior resection syndrome after rectal cancer surgery. Ann Coloproctol 2024; 40:234-244. [PMID: 38946094 PMCID: PMC11362764 DOI: 10.3393/ac.2023.00542.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 07/02/2024] Open
Abstract
PURPOSE This study assessed the long-term outcomes and quality of life in patients who underwent sacral neuromodulation (SNM) due to low anterior resection syndrome (LARS). METHODS This single-center retrospective study, conducted from 2005 to 2021, included 30 patients (21 men; median age, 70 years) who had undergone total mesorectal excision with stoma closure and had no recurrence at inclusion. All patients were diagnosed with LARS refractory to conservative treatment. We evaluated clinical and quality-of-life outcomes after SNM through a stool diary, Wexner score, LARS score, the Fecal Incontinence Quality of Life (FIQL) questionnaire, and EuroQol-5D (EQ-5D) questionnaire. RESULTS Peripheral nerve stimulation was successful in all but one patient. Of the 29 patients who underwent percutaneous nerve evaluation, 17 (58.62%) responded well to SNM and received permanent implants. The median follow-up period was 48 months (range, 18-153 months). The number of days per week with fecal incontinence episodes decreased from a median of 7 (range, 2-7) to 0.38 (range, 0-1). The median number of bowel movements recorded in patient diaries fell from 5 (range, 4-12) to 2 (range, 1-6). The median Wexner score decreased from 18 (range, 13-20) to 6 (range, 0-16), while the LARS score declined from 38.5 (range, 37-42) to 19 (range, 4-28). The FIQL and EQ-5D questionnaires demonstrated enhanced quality of life. CONCLUSION SNM may benefit patients diagnosed with LARS following rectal cancer surgery when conservative options have failed, and the treatment outcomes may possess long-term sustainability.
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Affiliation(s)
| | - Gabriel Marin
- Unit of Coloproctology, University Hospital of Navarra, Pamplona, Spain
| | - Ana Acevedo
- General Surgery Service, Reina Sofia Hospital, Tudela, Spain
| | - Ana Hernando
- Unit of Coloproctology, University Hospital of Navarra, Pamplona, Spain
| | - Alfonso Álvarez
- General Surgery Service, Reina Sofia Hospital, Tudela, Spain
| | - Fabiola Oteiza
- Unit of Coloproctology, University Hospital of Navarra, Pamplona, Spain
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Meng LH, Mo XW, Yang BY, Qin HQ, Song QZ, He XX, Li Q, Wang Z, Mo CL, Yang GH. To explore the pathogenesis of anterior resection syndrome by magnetic resonance imaging rectal defecography. World J Gastrointest Surg 2024; 16:529-538. [PMID: 38463367 PMCID: PMC10921216 DOI: 10.4240/wjgs.v16.i2.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/26/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Over 90% of rectal cancer patients develop low anterior resection syndrome (LARS) after sphincter-preserving resection. The current globally recognized evaluation method has many drawbacks and its subjectivity is too strong, which hinders the research and treatment of LARS. AIM To evaluate the anorectal function after colorectal cancer surgery by quantifying the index of magnetic resonance imaging (MRI) defecography, and pathogenesis of LARS. METHODS We evaluated 34 patients using the standard LARS score, and a new LARS evaluation index was established using the dynamic images of MRI defecography to verify the LARS score. RESULTS In the LARS score model, there were 10 (29.41%) mild and 24 (70.58%) severe cases of LARS. The comparison of defecation rate between the two groups was 29.36 ± 14.17% versus 46.83 ± 18.62% (P = 0.004); and MRI-rectal compliance (MRI-RC) score was 3.63 ± 1.96 versus 7.0 ± 3.21 (P = 0.001). Severe and mild LARS had significant differences using the two evaluation methods. There was a significant negative correlation between LARS and MRI-RC score (P < 0.001), and they had a negative correlation with defecation rate (P = 0.028). CONCLUSION MRI defecography and standard LARS score can both be used as an evaluation index to study the pathogenesis of LARS.
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Affiliation(s)
- Ling-Hou Meng
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xian-Wei Mo
- Department of Colorectal and Anal Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Bing-Yu Yang
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hai-Quan Qin
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qing-Zhou Song
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xin-Xin He
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qiang Li
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zheng Wang
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Chang-Lin Mo
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Guo-Hai Yang
- First Department of Chemotherapy, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Parnasa SY, Mizrahi I, Helou B, Cohen A, Abu Gazala M, Pikarsky AJ, Shussman N. Incidence and Risk Factors for Low Anterior Resection Syndrome following Trans-Anal Total Mesorectal Excision. J Clin Med 2024; 13:437. [PMID: 38256571 PMCID: PMC10816902 DOI: 10.3390/jcm13020437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Trans-anal total mesorectal excision (Ta-TME) is a novel approach for the resection of rectal cancer. Low anterior resection syndrome (LARS) is a frequent functional disorder that might follow restorative proctectomy. Data regarding bowel function after Ta-TME are scarce. The aim of this study was to evaluate the incidence and risk factors for the development of LARS following Ta-TME. METHODS A prospectively maintained database of all patients who underwent Ta-TME for rectal cancer at our institution was reviewed. All patients who were operated on from January 2018 to December 2021 were evaluated. The LARS score questionnaire was used via telephone interviews. Incidence, severity and risk factors for LARS were evaluated. RESULTS Eighty-five patients underwent Ta-TME for rectal cancer between January 2018 and December 2021. Thirty-five patients were excluded due to ostomy status, death, local disease recurrence, ileal pouch or lack of compliance. Fifty patients were included in the analysis. LARS was diagnosed in 76% of patients. Anastomosis distance from dentate line was identified as a risk factor for LARS via multivariate analysis (p = 0.042). Neo-adjuvant therapy, hand sewn anastomosis and anastomotic leak did not increase the risk of LARS. CONCLUSION LARS is a frequent condition following ta-TME, as it is used for other approaches to low anterior resection. Anastomosis distance from dentate line is an independent risk factor for LARS. In this study neo-adjuvant therapy, hand sewn anastomosis and anastomotic leak did not increase the risk of LARS. Further studies with longer follow-up times are required to better understand the functional outcomes following Ta-TME.
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Affiliation(s)
| | | | | | | | | | | | - Noam Shussman
- Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (S.Y.P.)
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Shen Y, Yang T, Zeng H, Meng W, Deng X, Wei M, Wang Z. Low anterior resection syndrome and quality of life after intersphincteric resection for rectal cancer: a propensity score-matched study. Tech Coloproctol 2023; 27:1307-1317. [PMID: 37804461 DOI: 10.1007/s10151-023-02848-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Our aim was to perform a propensity score-matched study to compare the long-term functional outcomes and quality of life following intersphincteric resection vs. low anterior resection (LAR) with very low anastomosis. METHODS Patients who underwent intersphincteric resection or low anterior resection with low anastomosis (≤ 4 cm from the anal verge) for rectal cancer between January 2017 and June 2020 were retrospectively included. A propensity score-matching process was performed. Functional outcomes and quality of life were assessed using the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), EORC-QLQ C30, EORC-QLQ CR29, Low Anterior Resection Syndrome (LARS), Wexner, and International Prostate Symptom Score (IPSS) questionnaires. The primary outcome was the presence of LARS at least 12 months after surgery. The second outcome was the postoperative quality of life of included patients. RESULTS After propensity matching, 128 patients were included, including 58 males and 70 females with a median age of 59.5. Patients in the intersphincteric resection group showed a higher incidence of incontinence to flatus (32.8% versus 14.0%, p = 0.043) and stools (42.2% versus 21.9%, p = 0.046), pain/discomfort (25.0% versus 7.8%, p = 0.001), and bowel dysfunction, while the LARS scores (15.0 versus 13.2, p = 0.461) and major LARS rates (26.6% versus 14.1%, p = 0.078) were comparable in both groups. CONCLUSION ISR leads to increased bowel incontinence rate and increased anal pain, without affecting the grade of low anterior resection syndrome, fecal urgency, and clustering. LAR might be the preferred sphincteric-preserving approach when negative resection margins and a safe anastomosis are guaranteed. Patients should be fully informed about potential functional impairment after sphincter-preservation procedures.
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Affiliation(s)
- Y Shen
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - T Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - H Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - W Meng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China
| | - X Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
| | - M Wei
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
| | - Z Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China.
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Tirelli F, Lorenzon L, Biondi A, Neri I, Santoro G, Persiani R. Functional outcomes after transanal total mesorectal excision (TaTME): a random forest analysis to predict patients' outcomes. Tech Coloproctol 2023; 27:1037-1046. [PMID: 36871281 PMCID: PMC9985820 DOI: 10.1007/s10151-023-02775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Anorectal, sexual, and urinary dysfunction are common issues after rectal cancer surgery, although seldom explored. The primary aim of this study was to investigate postoperative anorectal functional results. METHODS Patients with mid/low-rectal cancer treated with transanal TME (TaTME) with primary anastomosis with/without diverting stoma between 2015 and 2020 were reviewed and selected if they had a minimum follow-up of 6 months (from the primary procedure or stoma reversal). Patients were interviewed using validated questionnaires and the primary outcome was bowel function based on Low Anterior Resection Syndrome (LARS) scores. Statistical analyses were performed to identify clinical/operative variables correlated with worse outcomes. A random forest (RF) algorithm was computed to classify patients at a greater risk of minor/major LARS. RESULTS Ninety-seven patients were selected out of 154 TaTME performed. Overall, 88.7% of the patients had a protective stoma and 25.8% reported major LARS at mean follow-up of 19.0 months. Statistical analyses documented that age, operative time, and interval to stoma reversal correlated with LARS outcomes. The RF analysis disclosed worse LARS symptoms in patients with longer operative time (> 295 min) and stoma reversal interval (> 5.6 months). If the interval ranged between 3 and 5.6 months, older patients (> 65 years) reported worse outcomes. Finally, no statistical difference was documented when comparing the rate of minor/major LARS in the first 27 cases versus others. CONCLUSION One-quarter of the patients developed major LARS after TaTME. An algorithm based on clinical/operative variables, such as age, operative time, and time to stoma reversal, was developed to identify categories at risk for LARS symptoms.
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Affiliation(s)
- F Tirelli
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - L Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - A Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - I Neri
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - G Santoro
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
| | - R Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
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Pape E, Burch J, van Ramshorst GH, van Nieuwenhove Y, Taylor C. Intervention pathways for low anterior resection syndrome after sphincter-saving rectal cancer surgery: A systematic scoping review. Colorectal Dis 2023; 25:538-548. [PMID: 36356956 DOI: 10.1111/codi.16412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/29/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022]
Abstract
AIM Low anterior resection syndrome (LARS) has a large impact on patients' quality of life. Several heterogeneous intervention pathways are suggested in the literature. The steps and timing of the different steps in the pathways are unclear. This systematic scoping review aims to map the range of intervention pathways for LARS after sphincter-saving rectal cancer surgery. METHODS A search was undertaken on four databases (CINAHL, EMBASE, PubMed, and Web of Science). Any type of paper describing intervention pathways for patients with LARS following sphincter-saving surgery was included. Excluded were patients with a stoma, no full paper, no intervention pathway and not being written in English or Dutch. The review was registered with Open Science Framework (10.17605/OSF.IO/JB5H8). Narrative synthesis of the results was performed by charting and summarising key results. RESULTS A total of 373 records were screened and 12 papers were included. There was a high variability among the intervention pathways, including which patients should be included. The number of pathway steps ranged from 2-6. Most intervention pathways were treatment-led. Intervention options ranged from conservative measures to a permanent stoma. Pathway flow was highly variable and sometimes not well described, with different or no timings provided for the start, progression, or end of the pathways. Three studies discussed the use of a nurse to coordinate the pathway. CONCLUSION This systematic scoping review shows that despite similarities in treatment options there are variations in which treatments are included, when treatments should be instigated, and even which patients should be treated.
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Affiliation(s)
- Eva Pape
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Jennie Burch
- Oncological St Mark's Hospital, Part of London North West University Healthcare NHS Trust, London, UK
| | | | - Yves van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Claire Taylor
- Oncological St Mark's Hospital, Part of London North West University Healthcare NHS Trust, London, UK
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Ri H, Kang H, Xu Z, Kim K, Ren Y, Gong Z, Chen X. The risk factors of low anterior resection syndrome after colorectal cancer surgery: A retrospective study of 566 patients in a single institution in China. Front Surg 2022; 9:990702. [PMID: 36439535 PMCID: PMC9683037 DOI: 10.3389/fsurg.2022.990702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 09/02/2023] Open
Abstract
PURPOSE This study aims to identify the independent risk factors in the low anterior resection syndrome (LARS) after surgery for colorectal cancer (CRC). METHOD This was a retrospective, single-institution study in the Second Affiliation Hospital of Dalian Medical University, China. Patients underwent sphincter-preserving low anterior resection with total or partial mesorectal resection (with or without protective ileostomy) and completed a self-filled questionnaire over the phone to assess postoperative bowel dysfunction from January 2017 to December 2019. The predictors of LAR were evaluated using univariate and multivariate analyses. RESULT The study population was 566 patients, 264 (46.64%), 224 (39.58%), and 78 (13.78%) patients with no, minor, and major LARS, respectively. In the univariate analysis, independent factors such as tumor location and size, anastomotic height, protective ileostomy, post-operation chemoradiotherapy, tumor T stage, lymphatic nodal metastasis classification, surgery duration, and time interval for closure of stoma were significantly associated with LARS points while we found the tumor T stage and lymphatic nodal metastasis classification as the new independent risk factors compared with the last decade studies. In the multivariate analysis, factors such as low and middle tumor location and protective ileostomy, and post operation treatment, nodal metastasis classification were the independent risk factors for major LARS. CONCLUSION The new independence risk factors were tumor T stage and lymphatic nodal metastasis status in univariate analysis in our study, with anastomotic height, low and middle tumor location, protective ileostomy, post-operation chemoradiotherapy, nodal metastasis status increasing LARS point in multivariate analysis after surgery for CRC.
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Affiliation(s)
- HyokJu Ri
- Department of Hernia and Colorectal Surgery, The Second Affiliation Hospital of Dalian Medical University, Dalian, China
- Department of Colorectal Surgery, The Hospital of Pyongyang Medical College, Pyongyang, Democratic people's republic of Korea, Korea
| | - HaoNan Kang
- Department of Hernia and Colorectal Surgery, The Second Affiliation Hospital of Dalian Medical University, Dalian, China
| | - ZhaoHui Xu
- Department of Hernia and Colorectal Surgery, The Second Affiliation Hospital of Dalian Medical University, Dalian, China
| | - KunHyok Kim
- Department of Hernia and Colorectal Surgery, The Second Affiliation Hospital of Dalian Medical University, Dalian, China
- Department of Pathophysiology, The University of Hamhung Medical College, Hamhung, Democratic people's republic of Korea, Korea
| | - YanYing Ren
- Department of Hernia and Colorectal Surgery, The Second Affiliation Hospital of Dalian Medical University, Dalian, China
| | - ZeZhong Gong
- Department of Hernia and Colorectal Surgery, The Second Affiliation Hospital of Dalian Medical University, Dalian, China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Affiliation Hospital of Dalian Medical University, Dalian, China
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MRI measurements predict major low anterior resection syndrome in rectal cancer patients. Int J Colorectal Dis 2022; 37:1239-1249. [PMID: 35503128 DOI: 10.1007/s00384-022-04169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Current low anterior resection syndrome (LARS) score is lagging behind and only based on clinical symptoms patient described. Preoperative imaging indicators which can be used to predict LARS is unknown. We proposed preoperative MRI parameters for identifying major LARS. METHODS Patients receiving curative restorative anterior resection from Sept. 2007 to Sept. 2015 were collected to complete LARS score (median 75.7 months since surgery). MRI measurements associated with LARS were tested, and a multivariate logistic model was conducted for predicting LARS. Receiver operating characteristic curve was used to evaluate the model. RESULTS Two hundred fifty-five patients undergoing neoadjuvant chemoradiotherapy and 72 patients undergoing direct surgery were enrolled. The incidence of major LARS in NCRT group was significantly higher (53.3% vs.34.7%, P = 0.005). In patients with neoadjuvant chemoradiotherapy, the thickness of ARJ (TARJ), the distance between the tumor's lower edge and anal rectal joint (DTA), and sex were independent factors for predicting major LARS; ORs were 0.382 (95% CI, 0.198-0.740), 0.653 (95% CI, 0.565-0.756), and 0.935 (95% CI, 0.915-0.955). The AUC of the multivariable model was 0.842 (95% CI, 0.794-0.890). In patients with direct surgery, only DTA was the independent factor for predicting major LARS; OR was 0.958 (95% CI, 0.930-0.988). The AUC was 0.777 (95% CI: 0.630-0.925). CONCLUSIONS Baseline MRI measurements have the potential to predict major LARS in rectal cancer, which will benefit the decision-making and improve patients' life quality.
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Park EJ, Baik SH. Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2021.00142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sphincter preservation and organ restoration during rectal cancer surgery avoids permanent stoma creation and diminishes psychosocial damages. However, decreased rectal volumes and sphincter dysfunction—including pelvic nerve damage—results in low anterior resection syndrome, as well as urinary and sexual dysfunction after rectal resection. Bowel habit changes such as fecal incontinence, fecal urgency, frequent bowel movements, clustered stools, and difficulties in bowel emptying can be treated using medications, pelvic floor rehabilitation, sacral neuromodulation, or neorectal reservoir reconstruction. Pelvic nerve damage resulting from superior and inferior hypogastric plexi during sphincter-preserving rectal cancer surgery can induce urologic and sexual dysfunctions. Preoperative voiding difficulty, perioperative blood loss, and autonomic nerve injury are considered independent risk factors for postoperative urinary dysfunction. Retrograde ejaculation and erectile dysfunction, female dyspareunia, and vaginal dryness are manifestations of sexual dysfunction resulting from autonomic nerve injury during rectal cancer surgery. Multifactorial causes for functional outcomes after sphincter- preserving surgeries are considered to improve patient’s quality of life with acceptable oncologic outcomes in the treatment of rectal cancer patients.
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Ng KS, Gladman MA. LARS: A review of therapeutic options and their efficacy. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zheng H, Li Z, Zheng S, Li J, Zhao E. A Retrospective Study on the Feasibility of Completely Laparoscopic Transabdominal Approach Partial Intersphincteric Resection. J Laparoendosc Adv Surg Tech A 2021; 32:620-626. [PMID: 34492203 DOI: 10.1089/lap.2021.0544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background: With the development of surgical techniques, gastrointestinal surgeons seek ways to improve the quality of life (QOL) for postoperative patients, while ensuring the tumor radical effect, such as reducing trauma, alleviating pain, and preserving the anus. This article discusses the postoperative outcomes of completely laparoscopic transabdominal approach partial intersphincteric resection (CLTPISR). Materials and Methods: The clinical data of 68 patients who underwent CLTPISR at the Affiliated Hospital of Chengde Medical College between May 2017 and June 2020, including procedure-related data, general postoperative conditions, and postoperative anal function data, were retrospectively analyzed to investigate the feasibility and safety of CLTPISR. Results: All 68 rectal cancer patients completed the CLTPISR. The average age was (60.47 ± 7.08) years, the average operative time was (196.22 ± 8.15) minutes, the mean operative bleeding was (49.12 ± 29.61) mL, and the average postoperative hospital stay was (13.46 ± 4.78) days. The postoperative pathology showed that the circumferential margins and distal margins were all negative, the maximum tumor diameter was (3.26 ± 1.11) cm, the distance from the anal verge was (3.92 ± 0.89) cm, and the average number of lymph nodes cleared was (11.06 ± 3.67). There were 28 stage I patients (41.18%), 21 stage II patients (30.88%), and 19 stage III patients (27.94%). The median follow-up time after surgery was 28 months, and the rates of distant metastasis, disease-free survival, and overall survival of the patients were 8.82%, 91.18%, and 95.59%, respectively. The patient's postoperative anal function gradually recovered as time increased. Conclusions: Under the premise of strictly grasping the indications, the CLTPISR is a safe and feasible surgery. It could achieve maximum anal preservation and improve patients' QOL, while maintaining the tumor radical effect, and had the advantages of the short operation time, low intraoperative bleeding, and quick recovery. The Clinical Trial Registration number is LL2020397.
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Affiliation(s)
- Honghong Zheng
- Department of Gastrointestinal Surgery and Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zhehong Li
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Shuai Zheng
- Department of Gastrointestinal Surgery and Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jianjun Li
- Department of Gastrointestinal Surgery and Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Enhong Zhao
- Department of Gastrointestinal Surgery and Affiliated Hospital of Chengde Medical University, Chengde, China
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Sacomori C, Lorca LA, Martinez-Mardones M, Salas-Ocaranza RI, Reyes-Reyes GP, Pizarro-Hinojosa MN, Plasser-Troncoso J. A randomized clinical trial to assess the effectiveness of pre- and post-surgical pelvic floor physiotherapy for bowel symptoms, pelvic floor function, and quality of life of patients with rectal cancer: CARRET protocol. Trials 2021; 22:448. [PMID: 34256795 PMCID: PMC8276537 DOI: 10.1186/s13063-021-05396-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background There is scarcity of trials about preventative strategies for low anterior resection syndrome (LARS) in rectal cancer patients. The aim of this study is to evaluate the effectiveness of a pre- and post-surgical pelvic floor rehabilitation program on the bowel symptoms, pelvic floor function, and quality of life of rectal cancer patients. Methods A randomized controlled trial with parallel groups (pelvic floor rehabilitation versus control group), with a blinded evaluator. Participants and setting: 56 stage I to III rectal cancer patients aged from 18 to 80 years old undergoing sphincter preservation surgery at Hospital del Salvador and who have a sufficient knowledge of Spanish. Main outcome measures: ICIQ-B questionnaire for intestinal symptoms, high-resolution anorectal manometry (Alacer Multiplex 24-channel manometry equipment) for anorectal function, pelvic floor muscle strength test with Oxford Modified Scale, and a quality of life test with the EORTC QLQ C30 questionnaire. The evaluations will be carried out at five stages: before surgery, before and after the pelvic floor rehabilitation, and during a 3-month and 1-year follow-up. Interventions: one pre-rehabilitation session and 9 to 12 sessions of pelvic floor rehabilitation, including patient education, pelvic floor muscle exercises, pelvic floor electromyography biofeedback, and capacitive and sensory rectal training with a balloon probe. Rehabilitation will begin 3–5 weeks before the ileostomy is removed (four sessions) and around 3 weeks after stoma removal (5–8 sessions). Discussion We expect the program to improve the bowel symptoms, pelvic floor function, and quality of life of rectal cancer patients. Trial registration Australian New Zealand Clinical Trials Register ACTRN12620000040965. Registered on 21 January 2020.
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Affiliation(s)
- Cinara Sacomori
- Universidad Bernardo O'Higgins, Escuela de Kinesiología, Santiago, Chile.
| | - Luz Alejandra Lorca
- Hospital del Salvador, Servicio de Medicina Física y Rehabilitación, Santiago, Chile
| | - Mónica Martinez-Mardones
- Hospital del Salvador, Servicio de Cirugía y Servicio de Coloproctologia, Santiago, Chile.,Universidad Finnis Terrae, Escuela de Medicina, Santiago, Chile
| | | | | | | | - Jorge Plasser-Troncoso
- Hospital del Salvador, Servicio de Cirugía y Servicio de Coloproctologia, Santiago, Chile.,Fundación Arturo López Pérez, Santiago, Chile
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16
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Kim S, Kang SI, Kim SH, Kim JH. The Effect of Anastomotic Leakage on the Incidence and Severity of Low Anterior Resection Syndrome in Patients Undergoing Proctectomy: A Propensity Score Matching Analysis. Ann Coloproctol 2021; 37:281-290. [PMID: 34098631 PMCID: PMC8566143 DOI: 10.3393/ac.2021.03.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Proctectomy for the treatment of rectal cancer results in inevitable changes to bowel habits. Symptoms such as fecal incontinence, constipation, and tenesmus are collectively referred to as low anterior resection syndrome (LARS). Among the several risk factors that cause LARS, anastomotic leakage (AL) is a strong risk factor for permanent stoma formation. Therefore, the purpose of this study was to investigate the relationship between the severity of LARS and AL in patients with rectal cancer based on the LARS score and the Memorial Sloan Kettering Cancer Center (MSKCC) defecation symptom questionnaires. Methods We retrospectively analyzed patients who underwent low anterior resection for rectal cancer since January 2010. Patients who completed the questionnaire were classified into the AL group and control group based on medical and imaging records. Major LARS and MSKCC scores were analyzed as primary endpoints. Results Among the 179 patients included in this study, 37 were classified into the AL group. After propensity score matching, there were significant differences in the ratio of major LARS and MSKCC scores of the control group and AL group (ratio of major LARS: 11.1% and 37.8%, P < 0.001; MSKCC score: 67.29±10.4 and 56.49±7.2, respectively, P < 0.001). Univariate and multivariate analyses revealed that AL was an independent factor for major LARS occurrence and MSKCC score. Conclusion This study showed that AL was a significant factor in the occurrence of major LARS and defecation symptoms after proctectomy.
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Affiliation(s)
- Sungjin Kim
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - So Hyun Kim
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae-Hwang Kim
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
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Kent I, Jahansouz C, Ghuman A, Shpitz B, Kidron D, Yaffe V, Abu El-Naaj I, Araidy S, Reina L, Pitaru S, Wexner SD, Avital S. Human Oral Mucosal Stem Cells Reduce Anastomotic Leak in an Animal Model of Colonic Surgery. Eur Surg Res 2021; 62:32-39. [PMID: 33902028 DOI: 10.1159/000514987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anastomotic leak is regarded as one of the most feared complications of bowel surgery; avoiding leaks is a major priority. Attempts to reduce or eliminate leaks have included alternate anastomotic techniques. Human oral mucosa stem cells (hOMSC) are self-renewing and expandable cells derived from buccal mucosa. Studies have shown that hOMSC can accelerate tissue regeneration and wound healing. The objective of this study was to evaluate whether hOMSC can decrease anastomotic leak rates in a murine model of colon surgery. METHODS Two experiments were performed. In the first study, mice underwent colonic anastomosis using five interrupted sutures. hOMSC (n = 7) or normal saline (NS; n = 17) was injected into the colon wall at the site of the anastomosis. To evaluate whether hOMSC can impact anastomotic healing, the model was stressed by repeating the first experiment, reducing the number of sutures used for the construction of the anastomosis from five to four. Either hOMSC (n = 8) or NS (n = 20) was injected at the anastomosis. All mice that survived were sacrificed on postoperative day 7. Anastomotic leak rate, mortality, daily weight, and daily wellness scores were compared. RESULTS In the five-suture anastomosis, there were no differences in anastomotic leak rate, mortality, or daily weight. Mice that received hOMSC had significantly higher wellness scores on postoperative day 2 (p < 0.05). In the four-suture anastomosis, there was a significant decrease in leak rate (70% [NS] vs. 25% [hOMSC], p = 0.029) and higher wellness scores in mice that received hOMSC (p < 0.05). CONCLUSION Our study suggests that injecting hOMSC at the colonic anastomosis can potentially reduce anastomotic leak and improve postoperative wellness in a murine model of colon surgery.
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Affiliation(s)
- Ilan Kent
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cyrus Jahansouz
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amandeep Ghuman
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baruch Shpitz
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debora Kidron
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Yaffe
- Department of Cranio-Maxillofacial Surgery, Baruch Padeh Medical Center, Poria, Israel
| | - Imad Abu El-Naaj
- Department of Cranio-Maxillofacial Surgery, Baruch Padeh Medical Center, Poria, Israel
| | - Shareef Araidy
- Department of Cranio-Maxillofacial Surgery, Baruch Padeh Medical Center, Poria, Israel
| | - Luciana Reina
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sandu Pitaru
- Department of Oral Biology, School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Steven David Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Shmuel Avital
- Department of Surgery, Meir Medical Center, Kfar Saba, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Keane C, Paskaranandavadivel N, Vather R, Rowbotham D, Arkwright J, Dinning P, Bissett I, O'Grady G. Altered colonic motility is associated with low anterior resection syndrome. Colorectal Dis 2021; 23:415-423. [PMID: 33253472 DOI: 10.1111/codi.15465] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022]
Abstract
AIM Patients frequently suffer from low anterior resection syndrome (LARS) after distal colorectal resection. The pathophysiology of LARS has not been clearly elucidated. We hypothesized that rectosigmoid resection could impair motility patterns in the distal colon, such as the rectosigmoid brake, which contribute to control of stool form and frequency. METHOD High-resolution colonic manometry was performed in patients who had previously undergone distal colorectal resection (mean 6.8 years after resection) and non-operative controls before and after a standardized meal. Symptoms were assessed using the LARS score. Propagating contractions were compared between patients with and without LARS, and controls. RESULTS Data were analysed from 23 patients (11 no-LARS; 12 LARS) and nine controls. All groups demonstrated a significant meal response. LARS patients had fewer post-prandial antegrade propagating contractions than controls (P = 0.028), and fewer retrograde propagating contractions both pre- (P = 0.005) and post-prandially (P = 0.004). Post-prandially, the LARS group had a significantly lower percentage of propagating contractions that met the criteria for the cyclic motor pattern compared to the control group (26% vs. 58%; P = 0.009). There were significant differences in antegrade and retrograde amplitude (P = 0.049; P = 0.018) and distance of propagation (P = 0.003; P = 0.002) post-prandially between LARS patients and controls. CONCLUSION Rectosigmoid resection alters the meal response following anterior resection, including impairment of the rectosigmoid brake cyclic motor pattern. These findings help to quantify the impaired functional motility after rectosigmoid resection and offer new insights into the mechanisms of LARS.
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Affiliation(s)
- Celia Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Ryash Vather
- Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Rowbotham
- Department of Gastroenterology, Auckland City Hospital, Auckland, New Zealand
| | - John Arkwright
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Phil Dinning
- Department of Surgery and Gastroenterology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Ian Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Knowledge, attitudes, practices, and related factors of low anterior resection syndrome management among colorectal surgery nurses: a multicenter cross-sectional study. Support Care Cancer 2021; 29:4129-4136. [PMID: 33409723 DOI: 10.1007/s00520-020-05922-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE With the widespread development of low and ultra-low rectal sphincter-preservation surgery, low anterior resection syndrome, a new clinical challenge, has received increased attention. As the principal practitioners of this syndrome management, colorectal surgery nurses require sufficient relevant knowledge and skills, but few studies have been conducted of their actual ability and practice of managing the syndrome. The study adopted a knowledge, attitude, and practice model to evaluate low anterior resection syndrome management among colorectal surgery nurses. METHOD A multicenter cross-sectional study was conducted, in which 361 registered nurses in colorectal surgery from 6 hospitals in 4 cities were enrolled. A structured paper questionnaire was used to collect demographics, scale scores for knowledge, attitudes and management practice, and training needs. RESULTS Participants scored poorly in knowledge, attitude, and practice. Whether training had been received or not was an important factor affecting the knowledge, attitude, and practice of nurses, and the majority of participants had not received training. Nurses with lower levels of education had worse knowledge and practice, and contract nurses scored lower than staff nurses in terms of knowledge and attitude. CONCLUSIONS The critical role of nurses in patient management places high demands on their knowledge, attitude, and practice. However, the present study demonstrated that the current knowledge, attitude, and practice of colorectal surgery nurses regarding the syndrome gave cause for concern, and whether training had been received was a key factor affecting these three aspects. Therefore, training is a key strategy to eliminate the gaps identified.
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Abstract
PURPOSE OF REVIEW Low anterior resection syndrome is a highly prevalent condition that can develop after anal sphincter-sparing surgery for rectal cancer and impair quality of life. In this review, we summarize the major features and pathophysiology of this syndrome and discuss treatment approaches. RECENT FINDINGS Quality of life correlates significantly with severity of low anterior resection syndrome. Prompt assessment and initiation of therapy are essential to rehabilitating damaged mechanical and neural structures. Anorectal manometry demonstrates a global decrease in sphincteric function postoperatively, though in many patients, function does recover. Transanal irrigation, pelvic floor rehabilitation, and biofeedback are the mainstays of the treatment of major LARS. Definitive stoma can be considered in therapy refractory LARS > 2 years. The development of low anterior resection syndrome likely involves an interplay between mechanical and neural pathways. Clinically, patients present at varying levels of severity, and scoring systems are available to help assess patient symptoms and guide therapy. Treatment approaches range from conservative therapies to biofeedback and sacral nerve stimulation. Future randomized controlled trials aimed at risk stratification of patients and development of severity-based treatment algorithms are warranted.
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Affiliation(s)
- Theresa H Nguyen
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, 7200 Cambridge Ave., Ste. 8B, BCM 901, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Reena V Chokshi
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, 7200 Cambridge Ave., Ste. 8B, BCM 901, Houston, TX, 77030, USA.
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Boullenois H, Lefevre JH, Creavin B, Voron T, Debove C, Chafai N, Parc Y. Long-term functional results and quality of life after redo rectal surgery: delayed versus immediate colo-anal anastomosis. Colorectal Dis 2020; 22:885-893. [PMID: 31976608 DOI: 10.1111/codi.14983] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/15/2019] [Indexed: 02/08/2023]
Abstract
AIM To compare the functional results and quality of life after delayed colo-anal anastomosis (DCAA) or immediate colo-anal anastomosis (ICAA) following redo rectal surgery. METHOD Twenty-six patients with DCAA between 2014 and 2018 were studied retrospectively (group A). Two control groups were used: 26 ICAA after redo surgery (group B) and 52 colo-anal anastomosis (CAA) after anterior resection (group C). Control groups were matched for age, sex, pelvic radiotherapy and time to surgery. Low Anterior Resection Syndrome (LARS) and Gastrointestinal Quality of Life Index (GIQLI) scores were used to assess function and quality of life. RESULTS The indications for surgery were comparable for groups A and B: anastomotic failure with chronic sepsis (38% vs 50%, P = 0.40), vaginal fistula (42% vs 42%, P = 1) and urinary fistula (20% vs 8%, P = 0.22) as well as the number of previous abdominal operations (1.3 ± 0.9 vs 1.1 ± 0.6, P = 0.19). The median LARS score in the first 2 years was 30 [interquartile range (IQR) 14-41] for group A, 23 (IQR 0-41) for group B and 22 (IQR 11-37) for group C. After 2 years, the median LARS score improved in each group [A, 21 (IQR 11-35); B, 18 (IQR 5-26); C, 13 (IQR 9-20)], but was still high in group A. There was a tendency toward more major LARS in group A than in group B (46% vs 27%; P = 0.149). There was no difference in the mean GIQLI score between groups A and B (120 ± 16 vs 117 ± 19; P = 0.53) at the end of the follow-up period. Time after stoma closure (< 2 years) and previous radiotherapy were risk factors for major LARS in all populations. CONCLUSION ICAA should be the procedure of choice where possible in redo surgery as it has better functional outcomes.
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Affiliation(s)
- H Boullenois
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - J H Lefevre
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - B Creavin
- Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - T Voron
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - C Debove
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - N Chafai
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Y Parc
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
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22
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Abstract
BACKGROUND Bowel dysfunction after low anterior resection is often assessed by determining the low anterior resection syndrome score. What is unknown, however, is whether this syndrome is already present in the general population and which nonsurgical factors are associated. OBJECTIVE The purpose of this study was to determine the prevalence of minor and major low anterior resection syndrome in the general Dutch population and which other factors are associated with this syndrome. DESIGN This was a cross-sectional study. SETTINGS The study was conducted within the general Dutch population. PATIENTS The Groningen Defecation and Fecal Continence Questionnaire was distributed among a general Dutch population-based sample (N = 1259). MAIN OUTCOME MEASURES Minor and major low anterior resection syndrome were classified according to the scores obtained. RESULTS The median, overall score was 16 (range, 0-42). Minor low anterior resection syndrome was more prevalent than the major form (24.3% vs 12.2%; p < 0.001). Bowel disorders, including fecal incontinence, constipation, and irritable bowel syndrome were associated with the syndrome, whereas sex, age, BMI, and vaginal delivery were not. Remarkably, patients with diabetes mellitus were significantly more prone to experience minor or major low anterior resection syndrome. The ORs were 2.8 (95% CI, 1.8-4.4) and 3.7 (95% CI, 2.2-6.2). LIMITATIONS We selected frequent comorbidities and other patient-related factors that possibly influence the syndrome. Additional important factors do exist and require future research. CONCLUSIONS Minor and major low anterior resection syndrome occur in a large portion of the general Dutch population and even in a healthy subgroup. This implies that the low anterior resection syndrome score can only be used to interpret the functional result of the low anterior resection provided that a baseline measurement of each individual is available. Furthermore, because people with low anterior resection syndrome often experience constipation and/or fecal incontinence, direct examination and diagnosis of these conditions might be a more efficient approach to treating patient bowel dysfunctions. See Video Abstract at http://links.lww.com/DCR/B110. ¿CÓMO DEBE INTERPRETARSE LA PUNTUACIÓN DEL SÍNDROME DE RESECCIÓN ANTERIOR BAJA?: La disfunción intestinal después de la resección anterior baja a menudo se evalúa determinando la puntuación del síndrome de resección anterior baja. Sin embargo, lo que se desconoce es si este síndrome ya está presente en la población general y qué factores no quirúrgicos están asociados.Determinar la prevalencia del síndrome de resección anterior baja menor y mayor en la población holandesa general y qué otros factores están asociados con este síndrome.Estudio transversal.Población holandesa general.El cuestionario de defecación y continencia fecal de Groningen se distribuyó entre una muestra general de población holandesa (N = 1259).El síndrome de resección anterior baja menor y mayor se clasificó de acuerdo con las puntuaciones obtenidas.La mediana de la puntuación general fue de 16.0 (rango 0-42). El síndrome de resección anterior baja menor fue más frecuente que la forma principal (24.3% versus 12.2%, (P <0.001). Los trastornos intestinales, incluyendo incontinencia fecal, estreñimiento y síndrome del intestino irritable se asociaron con el síndrome, mientras que el sexo, la edad y el cuerpo el índice de masa y el parto vaginal no lo hicieron. Notablemente, los pacientes con diabetes mellitus fueron significativamente más propensos a experimentar el síndrome de resección anterior baja menor o mayor. Las razones de probabilidad fueron 2.8 (IC 95%, 1.8-4.4) y 3.7 (IC 95%, 2.2 -6.2), respectivamente.Se seleccionaron las comorbilidades frecuentes y otros factores relacionados con el paciente que posiblemente influyen en el síndrome. Existen otros factores importantes que requieren investigación en el futuro.El síndrome de resección anterior baja menor y mayor ocurre en una gran parte de la población holandesa general e incluso en un subgrupo sano. Esto implica que la puntuación del síndrome de resección anterior baja solo se puede utilizar para interpretar el resultado funcional de la resección anterior baja, siempre que esté disponible una medición inicial de cada individuo. Además, dado que las personas con síndrome de resección anterior baja a menudo experimentan estreñimiento y/o incontinencia fecal, el examen directo y el diagnóstico de estas afecciones pueden ser un enfoque más eficiente para tratar las disfunciones intestinales de los pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B110.
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Eid Y, Bouvier V, Dejardin O, Menahem B, Chaillot F, Chene Y, Dutheil JJ, Juul T, Morello R, Alves A. 'French LARS score': validation of the French version of the low anterior resection syndrome (LARS) score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients: a study protocol. BMJ Open 2020; 10:e034251. [PMID: 32152168 PMCID: PMC7064062 DOI: 10.1136/bmjopen-2019-034251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Many bowel problems following low anterior resection (LAR) for rectal cancer considerably impair the quality of life (QoL) of patients. The LAR syndrome (LARS) scale is a self-report questionnaire to identify and assess bowel dysfunction after rectal cancer surgery. It has been translated and validated in several languages but not in French (metropolitan French). The primary objective is to adapt the LARS scale to the French language (called French-LARS score) and to assess its psychometric properties. Secondary objectives are to assess both the prevalence and severity of LARS and to measure their impact on QoL. METHODS AND ANALYSIS A French multicentre observational cohort study has been designed. The validation study will include translation of the LARS scale following the current international recommendations, assessment of its reliability, convergent and discriminant validities, sensitivity, internal consistency, internal validity and confirmatory analyses. One thousand patients will be enrolled for the analyses. The questionnaire will be initially administered to the first 100 patients to verify the adequacy and degree of comprehension of the questions. Then reproducibility will be investigated by a test-retest procedure in the following 400 patients.An analysis will be conducted to determine the correlation between the LARS score and the Quality of Life Questionnaire (QLQ; European Organization for Treatment and Research of Cancer's QLQ-C30, QLQ-CR29). Risk factors linked to QoL deterioration will be identified and their impact will be measured. This study will meet the need for a validated tool to improve patient care and QoL. ETHICS AND DISSEMINATION The institutional review board of the University Hospital of Caen and the ethics committee (CPP Nord Ouest I, 25 January 2019) approved the study. TRIAL REGISTRATION NUMBER NCT03569488.
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Affiliation(s)
- Yassine Eid
- Department of digestive surgery, University Hospital of Caen, Caen, France
- ANTICIPE" U1086 INSERM-University of Caen Normandy, Team « Ligue contre le Cancer », Centre François Baclesse, Caen, France
- Department of research, University Hospital of Caen, Normandy, France
| | - Véronique Bouvier
- ANTICIPE" U1086 INSERM-University of Caen Normandy, Team « Ligue contre le Cancer », Centre François Baclesse, Caen, France
- Digestive Cancer Registry of Calvados, University Hospital of Caen, Caen cedex, France
| | - Olivier Dejardin
- ANTICIPE" U1086 INSERM-University of Caen Normandy, Team « Ligue contre le Cancer », Centre François Baclesse, Caen, France
- Department of research, University Hospital of Caen, Normandy, France
| | - Benjamin Menahem
- Department of digestive surgery, University Hospital of Caen, Caen, France
| | - Fabien Chaillot
- Department of research, University Hospital of Caen, Normandy, France
| | - Yannick Chene
- Department of research, University Hospital of Caen, Normandy, France
| | | | - Therese Juul
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Rémy Morello
- Department of research, University Hospital of Caen, Normandy, France
- Department of biostatistics and clinical research, University Hospital of Caen, Caen cedex, France
| | - Arnaud Alves
- Department of digestive surgery, University Hospital of Caen, Caen, France
- ANTICIPE" U1086 INSERM-University of Caen Normandy, Team « Ligue contre le Cancer », Centre François Baclesse, Caen, France
- Department of research, University Hospital of Caen, Normandy, France
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Faron M, Laas E. [Does sentinel lymph node identification has indication in digestive cancers?]. Bull Cancer 2019; 107:660-665. [PMID: 31627907 DOI: 10.1016/j.bulcan.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
Despite being a standard of care in several cancers, sentinel lymph node (SLN) is not widespread in digestive cancers. European guidelines do not recommend its use for any digestive cancers. Particularity of the lymphatic vessel, intimately linked to blood vessel, may explain part of this phenomenon. Nevertheless, more indication could arise in the near future with the early diagnosis of tumor induced by cancer screening. Ruling out the lymphatic invasion could allow preserving the organ currently resected because of risk of lymph node positivity. This procedure is well studied in early gastric cancer in Korea and Japan. Several study have demonstrated that, a dual-tracer (isotopic and dye) allows to accurately identify the SLN. A randomized phase 3 trial is currently active in Korea to evaluate the oncological results of the procedure. Similar indication could arise for T1 tumor of the low-rectum, but currently available data are insufficient to recommend its use outside of a study. SLN may also be used to detect aberrant lymphatic drainage (rectum, ileum) but have been tested so far only in a few dozen of patients. Finally, SLN is disappointing in colon cancer, due to its low sensitivity and the absence of modification of the surgical procedure induced.
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Affiliation(s)
- Matthieu Faron
- Gustave-Roussy Cancer Campus, département de chirurgie viscérale oncologique, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France; Unité Inserm 1018 CESP Oncostat, Gustave-Roussy Cancer Campus, département de biostatistiques et épidémiologie, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - Enora Laas
- Institut Curie, service de chirurgie senologique, gynécologique et reconstructrice, 26, rue d'Ulm, 75005 Paris, France
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Eid Y, Menahem B, Bouvier V, Lebreton G, Thobie A, Bazille C, Finochi M, Fohlen A, Galais M, Dupont B, Lubrano J, Dejardin O, Morello R, Alves A. Has adherence to treatment guidelines for mid/low rectal cancer affected the management of patients? A monocentric study of 604 consecutive patients. J Visc Surg 2019; 156:281-290. [DOI: 10.1016/j.jviscsurg.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Eid Y, Bouvier V, Menahem B, Thobie A, Dolet N, Finochi M, Renier M, Gardy J, Launoy G, Dejardin O, Morello R, Alves A, Abdelli A, Ahkong MV, Alkofer B, Apoil B, Paul Argouarch L, Armand P, Arsène D, Auvray S, Barthélémy R, Bazille C, Laure Bignon A, Bonnamy C, Bouhier-Leporrier K, Borotto E, Brefort JL, Chomontovski J, Cohen D, Cojocaru M, Collet T, Congard P, Corbinais S, Couque M, Degoutte E, Desfachelles JP, Dupont B, Elfadel S, Galais MP, Genuist F, Girard N, Gloro R, Granveau A, Guilloit JM, Hervé S, Hessissen M, Jacob J, Kalinski E, Koutsomanis D, Lagriffoul L, Lartigau C, Lechevallier L, Lebreton G, Lefebvre AC, Lefrançois D, Lepoittevin C, Leporrier J, Le Roux Y, L’Hirondel A, L’Hirondel C, Lion L, Makki A, Marchand P, Marion Y, Mauger D, Mosquet L, Mura DN, Ollivier JM, Parzy A, Polycarpe E, Polycarpe F, Reijasse D, Renet C, Rodriguez C, Saadi L, Samama G, Saplacan M, Sleman F, Siriser F, Soufron J, Teste Y, Tiengou LE, Toudic JP. Digestive and genitourinary sequelae in rectal cancer survivors and their impact on health-related quality of life: Outcome of a high-resolution population-based study. Surgery 2019; 166:327-335. [DOI: 10.1016/j.surg.2019.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 02/06/2023]
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