Bowel dysfunction after treatment for rectal cancer

OBJECTIVE: The aims of this study were to investigate the convergent and discriminative validity and reliability of the low anterior resection syndrome (LARS) score in an international setting. BACKGROUND: The LARS score is a simple self-administered questionnaire measuring bowel dysfunction after rectal cancer surgery. The score is intended to be commonly used in international research and clinical practice in the future. Therefore, a thorough validation in an international setting is of utmost importance. METHODS: The LARS score was translated using methods in keeping with current international recommendations. A total of 801 patients operated for rectal cancer in Sweden, Spain, Germany, and Denmark completed the LARS score questionnaire, including an anchor question assessing the impact of bowel function on quality of life. A subgroup of 218 patients completed the LARS score twice. Data were analyzed per country. RESULTS: The LARS score has demonstrated a high convergent validity in terms of a high correlation between LARS score and quality of life (P < 0.001). Sensitivity ranged from 67.7% to 88.3% and specificity from 58.1% to 86.3%. The LARS score was able to discriminate between groups of patients differing with regard to radiotherapy, surgery, and age (P < 0.05). The score also demonstrated high reliability at test-retest with narrow limits of agreement and no statistically significant difference between scores at the first and second test. CONCLUSIONS: The Swedish, Spanish, German, and Danish versions of the LARS score have proven to be valid and reliable tools for measuring LARS in European rectal cancer patients.

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“…2,9 At the outset, it was decided to include more patients in Spain due to historically low response rates to questionnaires.…”

Section: Participantsmentioning

confidence: 99%

International Validation of the Low Anterior Resection Syndrome Score

Juul¹,

Ahlberg²,

Biondo³

et al. 2014

Annals of Surgery

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“…However, loss of the normal rectal reservoir function can result in severe post-operative bowel dysfunction. The resulting syndrome, Low Anterior Resection Syndrome (LARS), can severely impact on quality of life (QoL) and is estimated to affect 50% -90% of patients [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

A Cross-Sectional Review of Reporting Variation in Postoperative Bowel Dysfunction After Rectal Cancer Surgery

Chapman

Bolton²,

Corrigan³

et al. 2017

Diseases of the Colon &Amp; Rectum

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word count: 253 WordsContributions: DGJ and NY conceptualised the idea and had input to the study design. SJC and WB performed searches and collected data. SJC and NC performed statistical analysis. All authors contributed to the final writing of the manuscript. SJC and WSB contributed equally to this work and are joint first authors. DGJ is the study guarantor. AbstractBackground: Postoperative bowel dysfunction affects quality of life after sphincter-

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“…50-90% of RC patients experience some form of bowel dysfunction following anterior resection (AR) [15,16,17]. The low anterior resection syndrome (LARS) comprises symptoms like urgency, incontinence, frequent bowel movement, and clustering that may persist and thus impair long-term QoL after AR.…”

Section: Introductionmentioning

confidence: 99%

Overstaging: A Challenge in Rectal Cancer Treatment

et al. 2018

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Background: Preoperative staging, including computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), is decisive to envisage the therapeutic concept for rectal cancer (RC). Overstaging may subject the patient to neoadjuvant therapy that does not improve survival but may lead to therapy-associated morbidity. Methods: This study retrospectively compares and values EUS, CT, and MRI in Union Internationale Contre le Cancer (UICC) stage I-III RC with a focus on overstaging. RC patients receiving primary operation only at the University Clinic Ulm were analyzed. The therapeutic relevance of preoperative staging was determined by comparison with postoperative pathological workup. Results: 244 examinations in 184 RC patients (EUS: n = 63, CT: n = 143, MRI: n = 38) revealed therapy-relevant overstaging into the T3/4 category in 10 (16%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Patients were upgraded to the N+ category in 13 (21%) EUS, 29 (20%) CT, and 11 (29%) MRI cases. As a result, UICC stages II and III turned out to be overstaged in 13 (21%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Conclusion: More than 10% therapy-relevant overstaging by any method represents a major challenge for modern RC therapy. Physicians should scrupulously consider this fact in their treatment considerations to avoid overtreatment.

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Bowel dysfunction after treatment for rectal cancer

Cited by 87 publications

References 81 publications

International Validation of the Low Anterior Resection Syndrome Score

International Validation of the Low Anterior Resection Syndrome Score

A Cross-Sectional Review of Reporting Variation in Postoperative Bowel Dysfunction After Rectal Cancer Surgery

Overstaging: A Challenge in Rectal Cancer Treatment

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