Long-term bowel dysfunction following low anterior resection

Abstract

Study aimed to assess long-term bowel function in patients who underwent low anterior resection for cancer five and more years ago. Patients who underwent low anterior resection for rectal cancer from 2010 to 2015 at National Cancer Institute were prospectively included in our study. They were interviewed using low anterior resection syndrome (LARS) score and Wexner questionnaire. We also assessed possible risk factors of postoperative bowel disorder. 150 patients were included in our study. Of them 125 (83.3%) were analysed. The median age at diagnosis was 62 years (40-79), and the average time of follow-up was 7.5 years (5-11). Overall, 58 (46.4%) patients had LARS, of them 33 (26.4%)-major LARS and 25 (20%)-minor LARS and 67 (53.6%) reported no LARS. Wexner score results were: normal in 43 (34.4%) patients, minor faecal incontinence-55 (44%), average faecal incontinence-18 (14.4%), complete faecal incontinence-9 (7.2%). 51 patients (40.8%) had tumour in the upper third rectum, 51 (40.8%)-in the middle and 23 (18.4%)-lower third. Preoperative (chemo) radiotherapy was the only significant risk factors for developing LARS in univariate analysis. Our study showed that only preoperative radiotherapy may be associated with more late problems in defecation after rectal cancer surgery. Trial registration: NCT03920202. Rectal cancer (RC) is a frequent and fatal disease with high incidence rate in developed countries, possibly because of differences in environment and diet 1. The age standardized incidence rate among men and women in Europe, was 15-25/100.000 new cases of RC per year with a range of mortality from four to 10/100.000 2. For the last almost 30 years, the gold standard treatment for RC is low anterior resection (LAR) with total mesorectal excision (TME) as described by Heald 3. Unfortunately, up to 80% of patients undergoing LAR will suffer of bowel dysfunction including faecal urgency, frequent bowel movements, tenesmus or so called Low Anterior Resection Syndrome (LARS) 4. Simply it has been defined as "disordered bowel function after rectal resection, leading to a detriment in quality of life" 4. Same year LARS score was developed 5. This tool is easy to use and has been internationally and in Lithuania validated 6,7. Wexner score is another tool for evaluation of faecal continence 8. Recently Delphi consensus on LARS description was published. To meet the definition, a patient must have had an anterior resection (sphincterpreserving rectal resection) and experience at least 1 of suggested 8 symptoms that result in at least one of suggested 8 consequences 9. The advantaged of the Delphi approach is that unlike most patient-reported outcome measures that were initially produced by expert clinician researchers who then consulted patient populations, the Delphi definition of LARS actively involved all major stakeholders, especially patients, early in the construction to ensure that the resulting tool was fit for purpose. To our knowledge there are only five studies investigating long-term LARS following re...

Development and evaluation of a Japanese prediction model for low anterior resection syndrome after rectal cancer surgery

“…[19][20][21] On the other hand, preoperative radiation therapy is recommended for patients with advanced rectal cancer in Western countries, and it has been reported that the radiation therapy also leads to defecation disorders. [13,22] The incidence of major LARS after rectal cancer surgery has been reported to be more than 40% [22][23][24], and the incidence of major LARS was similar in this study.…”

A nomogram to predict risk factors of frequent defecation early after ileostomy reversal for rectal cancer patients

“…However, some complications may occur after radiotherapy, including rectal anastomotic leakage, anastomotic stenosis, and proctitis. Dulskas et al included patients who had received rectal cancer resection at the National Cancer Institute of Lithuania from 2010 to 2015, and found that preoperative chemoradiotherapy was confirmed to be a risk factor for postoperative defecation changes, which was similar to the results of many previous studies (28). Sun et al also showed that long-course neoadjuvant radiation, along with low anastomosis, are likely independent risk factors for postoperative bowel function and quality of life (QOL) (29).…”

Quality of Life and Bowel Function Following Early Closure of a Temporary Ileostomy in Patients with Rectal Cancer: A Report from a Single-Center Randomized Controlled Trial

“…This is obvious with quality of life, which is negatively affected, while period caring the ileostomy. The different scenario is with the bowel function, as our and other authors’ results showed that LARS is a long-term issue, without any significant change in a timeline [ 32 , 33 , 34 , 35 , 36 , 37 ]. In addition, we did not evaluate sexual and urinary functions that are also important parts of quality of life.…”