Factors influencing anterior/low anterior resection syndrome after rectal or sigmoid resections

Benli, Sami; Çolak, Tahsin; Türkmenoğlu, Özgür

doi:10.3906/sag-2007-145

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…These studies agree that major LARS is associated with a decreased HRQoL [14,15,31,32]. However, also, patient and treatment characteristics (e.g., age, radiotherapy, low anastomosis) of patients that develop major LARS are likely to influence HRQoL [31,33]. In this study, patients with major LARS had significantly more complaints of embarrassment than patients with a stoma, which can be an important issue to discuss with a patient when a high risk of major LARS is anticipated.…”

Section: Discussionsupporting

confidence: 64%

“…As stated, the decision between an anastomosis and a (temporary) stoma after sphincter-sparing rectal cancer surgery is motivated by the risk of adverse events (e.g., anastomotic leakage) and the expected functional outcomes [12,33,45]. However, since this decision is usually not a straightforward one, caused by the lack of a clinically "best choice," considering the risks of poor functional outcome makes this decision preference-sensitive and therefore particularly relevant for shared decision-making [34,46,47].…”

Section: Discussionmentioning

confidence: 99%

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Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

Algie

Kooten

Tollenaar

et al. 2022

Int J Colorectal Dis

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Background Surgical resection is the mainstay of curative treatment for rectal cancer. Post-operative complications, low anterior resection syndrome (LARS), and the presence of a stoma may influence the quality of life after surgery. This study aimed to gain more insights into the long-term trade-off between stoma and anastomosis. Methods All patients who underwent sphincter-sparing surgical resection for rectal cancer in the Leiden University Medical Center and the Reinier de Graaf Gasthuis between January 2012 and January 2016 were included. Patients received the following questionnaires: EORTC-QLQ-CR29, EORTC-QLQ-C30, EQ-5D-5L, and the LARS score. A comparison was made between patients with a stoma and without a stoma after follow-up. Results Some 210 patients were included of which 149 returned the questionnaires (70.9%), after a mean follow-up of 3.69 years. Overall quality of life was not significantly different in patients with and without stoma after follow-up using the EORTC-QLQ-C30 (p = 0.15) or EQ-5D-5L (p = 0.28). However, after multivariate analysis, a significant difference was found for the presence of a stoma on global health status (p = 0.01) and physical functioning (p < 0.01). Additionally, there was no difference detected in the quality of life between patients with major LARS or a stoma. Conclusion This study shows that after correction for possible confounders, a stoma is associated with lower global health status and physical functioning. However, no differences were found in health-related quality of life between patients with major LARS and patients with a stoma. This suggests that the choice between stoma and anastomosis is mainly preferential and that shared decision-making is required.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

Algie

Kooten

Tollenaar

et al. 2022

Int J Colorectal Dis

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“…Finally, the LARS score was higher in patients who were not obese and had undergone LAR, which is in agreement with the results of other studies [9,11,14]. Since it has been shown that sphincter-preserving surgery, such as AR and LAR, has negative effects on anorectal function, resulting in LARS [19], our study confirmed that patients who underwent LAR would develop LARS more frequently than those who underwent AR [20].…”

Section: Discussionsupporting

confidence: 91%

“…To draw a better picture of functional complaints in Vietnamese patients, a multi-center study is required. Another weak point of this study is that the LARS score was not able to discriminate patients who had undergone radiotherapy, even though radiotherapy has been proven to have a strong relationship to LARS [20].…”

Section: Discussionmentioning

confidence: 76%

Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire

Mai-Phan

Pham

2022

Ann Coloproctol

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The aim of this study was to validate the low anterior resection syndrome (LARS) score questionnaire in the Vietnamese language among Vietnamese patients who underwent sphincter-preserving surgery for rectal cancer. Methods: The LARS score questionnaire was translated from English into Vietnamese and then back-translated as recommended internationally. From January 2018 to December 2020, 93 patients who underwent sphincter-preserving surgery completed the Vietnamese version of the LARS score questionnaire together with an anchored question assessing the influence of bowel function on quality of life (QoL). To validate test-retest reliability, patients were requested to answer the LARS score questionnaire twice. Results: Ninety-three patients completed the LARS score questionnaire, of whom 89 responded twice. The patients who responded twice were included in the analysis of test-retest reliability. Fifty-eight patients had a "major" LARS score. The LARS score was able to discriminate between patients who were obese and those who were not (P < 0.001) and between the low anterior resection and anterior resection procedures (P < 0.001). Age and sex were not associated with higher LARS scores (P = 0.975). There was a perfect fit between the QoL category question and the LARS score in 56.2% of cases, and a moderate fit was found in 42.7% of cases, showing reasonable convergent validity. The test-retest reliability of 89 patients showed a high intraclass correlation coefficient. Conclusion: The Vietnamese version of the LARS score questionnaire is a valid tool for measuring LARS.

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“…A low tumour significantly increased the incidence of LARS, which could result from the difficulty of low rectal tumour resection and high anastomotic tension, easily leading to intestinal isospasm and stenosis at the proximal end of anastomosis 5,43,47 . The lower the distance between the tumour and the anal margin, the lower the position of the postoperative anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Development of prediction model of low anterior resection syndrome for colorectal cancer patients after surgery based on machine‐learning technique

Huang

Lin

et al. 2022

Cancer Medicine

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Background Low anterior resection syndrome (LARS) is a common postoperative complication in patients with colorectal cancer, which seriously affects their postoperative quality of life. At present, the aetiology of LARS is still unclear, but some risk factors have been studied. Accurate prediction and early management of medical intervention are keys to improving the quality of life of such high‐risk patients. Objectives Based on machine‐learning methods, this study used the follow‐up results of postoperative patients with colorectal cancer to develop prediction models for LARS and conducted a comparative analysis between the different models. Methods A total of 382 patients diagnosed with colorectal cancer and undergoing surgery at West China Hospital from April 2017 to December 2020 were retrospectively selected as the development cohort. Logistic regression, support vector machine, decision tree, random forest and artificial neural network algorithms were used to construct the prediction models of the obtained dataset. The models were internally validated using cross‐validation. The area under the curve and Brier score measures were used to evaluate and compare the differentiation and calibration degrees of the models. The sensitivity, specificity, positive predictive value and negative predictive value of the different models were described for clinical use. Results A total of 342 patients were included, the incidence of LARS being 47.4% (162/342) during the six‐month follow‐up. After feature selection, the factors influencing the occurrence of LARS were found to be location, distance, diverting stoma, exsufflation and surgical type. The prediction models based on five machine‐learning methods all showed acceptable performance. Conclusions The five models developed based on the machine‐learning methods showed good prediction performance. However, considering the simplicity of clinical use of the model results, the logistic regression model is most recommended. The clinical applicability of these models will also need to be evaluated with external cohort data.

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Factors influencing anterior/low anterior resection syndrome after rectal or sigmoid resections

Cited by 12 publications

References 23 publications

Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

Validation of the Vietnamese version of the low anterior resection syndrome score questionnaire

Development of prediction model of low anterior resection syndrome for colorectal cancer patients after surgery based on machine‐learning technique

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