Aim: to develop a conservative rehabilitation program for patients with severe symptoms of LARS.Patients and methods: since January 2019, 50 patients after low anterior resection were included in the study. The main group included 25 patients who underwent biofeedback therapy and tibial neuromodulation in 3–6 months after surgery. Functional results before and after treatment were evaluated by anorectal manometry. The control group included 25 patients, according to the Propensity score matching.Results: the median score on the LARS scale, in the main group was 41.0 ± 2.8 points, in the control — 38 ± 4. With sphincterometry, the median pressure at rest before treatment was 30.0 ± 7.8, with a voluntary contraction of 140.6 ± 56.0 mm Hg. After the conservative treatment, patients in the main group had significantly better results: the median score on the LARS scale decreased from 41 ± 2.8 to 17 ± 8 points (p < 0.0001), the median pressure after treatment increased from 30.0 ± 7.8 to 36.0 ± 8.0 (p = 0.004), with a voluntary contraction from 140.6 ± 56.0 to 157.5 ± 53.2 mmHg (p = 0.008). Comparing the results of the questionnaire of the main group with the control group after the stoma closure and after 12 months, it turned out that in the main group there was a significant decrease in the severity of LARS: 17.0 ± 8.0 scores vs. 35.0 ± 4.5 (p = 0.0003), which shows an improvement in the tone and contractility of the sphincter after conservative treatment.Conclusion: comprehensive biofeedback therapy and tibial neuromodulation improves the functional results of patients with severe LARS.
Introduction — Low anterior resection syndrome (LARS) is a socially significant problem that impedes social adaptation and contributes to deterioration of life quality in patients. The objective of this study was to search for the category of patients most prone to major LARS, as well as to identify the factors determining the severity of this syndrome manifestations. Material and Methods — Systematic review and meta-analysis were performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study selected publications that included the functional results of treatment of patients operated for rectal cancer. Functional impairments were assessed according to the international LARS Score. Statistical analysis was performed using the inverse-variance weighted average method (IVW) with calculation of the odds ratio logarithm and standard error of the mean. Results — After a critical search and analysis of all literature sources, eight studies were found suitable for meta-analysis. In total, 1042 patients (796 men and 246 women) were included into statistical analysis, 409 of which (39.2%) had symptoms of major LARS. Chemotherapy was performed on 637 (62.5%) patients, while 568 subjects (55.5%) underwent radiation therapy, and anastomotic leaks were described in 89 (8.5%) people. According to the results of the meta-analysis, statistically significant factors were: preventative ostomy (OR=3.32, 95% CI 1.99-5.55, p<0.00001), chemotherapy (OR=1.98, 95% CI 1.23-3, 19, p=0.005), radiation therapy (OR=5.00, 95% CI 2.73-9.13, p <0.00001), anastomotic leaks (OR=2.93, 95% CI 2.30-3, 73, p<0.00001), anal verge distance from anastomosis site (OR=2.61, 95% CI 1.47-4.62, p=0.001). Conclusion — The results of our meta-analysis allowed us identifying the group of rectal cancer patients most vulnerable to LARS. The risk of developing severe functional disorders is significantly higher in patients with low colorectal anastomosis, as well as in patients undergoing neoadjuvant radiation therapy.
Aim: search for modifiable and unmodifiable risk factors affecting the quality of life of patients after rectal cancer surgery.Materials and methods: the literature search was done according to the keywords: quality of life, rectal cancer, low anterior resection syndrome. Twelve prospective randomized studies, 2 cohort studies, and 2 meta-analyses are included in the study. The quality of life was assessed in the analyzed studies by using questionnaires for cancer patients and updated questionnaires for colorectal cancer: EORTC QLQ-CR29, QLQ-C30, QLQ-CR38, BIQ.Results: the literary data on influence of gender, age, surgery, stoma, and chemoradiotherapy on life quality of patients after rectal cancer surgery was analyzed.Conclusion: the most significant factor affecting the life quality of patients with rectal cancer is a violation of the body image if it is necessary to form the stoma on the anterior abdominal wall. The manifestations of the low anterior resection syndrome and the urination problems are significant risk factors in the case of restoration of bowel continuity.
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