Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study

Pieniowski, Emil; Nordenvall, Caroline; Palmer, Gabriella; Johar, Asif; Ekelund, Susanne; Lagergren, Pernilla; Abraham-Nordling, Mirna

doi:10.1002/bjs5.50312

Cited by 68 publications

(47 citation statements)

References 24 publications

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“…LARS can contribute to long-term bowel dysfunction [2,10] and can have a profound impact on patients' quality of life (QoL) [10]. Consequently, there has been considerable focus over the last few years on the assessment and appropriate management of LARS in patients undergoing sphincter-preserving rectal cancer surgery.…”

mentioning

confidence: 99%

A novel bowel rehabilitation programme after total mesorectal excision for rectal cancer: the BOREAL pilot study

et al. 2021

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Aim Low anterior resection syndrome (LARS) following sphincter‐preserving surgery for rectal cancer has a high prevalence, with an impact on long‐term bowel dysfunction and quality of life. We designed the bowel rehabilitation programme (BOREAL) as a proactive strategy to assess and treat patients with LARS. The BOREAL programme consists of a stepwise approach of escalating treatments: medical management (steps 0–1), pelvic floor physiotherapy, biofeedback and transanal irrigation (step 2), sacral nerve neuromodulation (step 3), percutaneous endoscopic caecostomy and anterograde enema (step 4) and definitive colostomy (step 5). Methods A pilot study was undertaken to assess the feasibility of collecting LARS data routinely with the parallel implementation of the BOREAL programme. All patients who underwent total mesorectal excision for rectal cancer between February 2017 and March 2019 were included. LARS was assessed using the LARS score and the Wexner Faecal Incontinence score at 30 days and 3, 6, 9 and 12 months postoperatively. A good functional result was considered to be a combined LARS score <20 and/or a Wexner score <4. Results In all, 137 patients were included. Overall compliance with the BOREAL programme was 72.9%. Major LARS decreased from 48% at 30 days postoperatively to 12% at 12 months, with a concomitant improvement in overall good function from 33% to 77%, P < 0.001. The majority of patients (n = 106, 77%) required medical management of their LARS. Conclusion The BOREAL programme demonstrates the acceptability, feasibility and effectiveness of implementing a responsive, stepwise programme for detecting and treating LARS.

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confidence: 99%

A novel bowel rehabilitation programme after total mesorectal excision for rectal cancer: the BOREAL pilot study

et al. 2021

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“…EORTC QLQ C30) and the faecal incontinence quality of life (FIQOL) instrument [30,47]. Quality of life has repeatedly been shown to correlate with LARS symptoms [48,49] and future studies should include quality of life assessment as standard.…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

Sequential assessment of bowel function and anorectal physiology after anterior resection for cancer: a prospective cohort study

Pilkington¹,

Bhome

Gilbert³

et al. 2021

Colorectal Disease

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Aim The aim of this study was to investigate changes in bowel function and anorectal physiology (ARP) after anterior resection for colorectal cancer. Method Patients were recruited from November 2006 to September 2008. Cleveland Clinic Incontinence (CCI) scores and stool frequency were determined by patient questionnaires before surgery (t0) and at three (t3), six (t6), nine (t9) and 12 (t12) months after restoration of intestinal continuity. ARP measurements were recorded at T0, T3 and T12. Endoanal ultrasound was performed at T0 and T12. Results Eighty‐nine patients were included. CCI score increased postoperatively then normalized, whereas stool frequency did not change. Patients who had neoadjuvant radiotherapy or a lower anastomosis had increased incontinence and stool frequency in the postoperative period, whereas those with defunctioning stomas or open surgery had increased stool frequency alone. Maximum resting pressure, volume at first urge and maximum rectal tolerance were reduced throughout the postoperative period. Radiotherapy, lower anastomosis and defunctioning stoma (but not operative approach) altered manometric parameters postoperatively. Maximum rectal tolerance correlated with incontinence and first urge with stool frequency. The length of the anterior internal anal sphincter decreased postoperatively. Conclusions Incontinence recovers in the first year after anterior resection. Radiotherapy, lower anastomosis, defunctioning stoma and open surgery have a negative influence on bowel function. ARP may be useful if bowel dysfunction persists beyond 12 months.

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“…LAR syndrome is a collection of symptoms that patients may develop after surgical resection of the rectum, with symptoms including increased urgency, frequency, and sexual dysfunction. The prevalence of LAR syndrome can range from 20-50% [ 22 ], though there are few high-quality studies demonstrating this. Alternatively, Guillem et al addressed the question of how many patients with T3-node-negative rectal cancer, staged by endoscopic ultrasound or magnetic resonance imaging (MRI), actually have more advanced disease.…”

Section: Overtreatmentmentioning

confidence: 99%

The evolution of rectal cancer treatment: the journey to total neoadjuvant therapy and organ preservation

Affleck¹

2022

aog

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There has been a staggering increase in the incidence of rectal cancer, drawing our attention to early detection and optimization of its medical and surgical treatment. With this review we highlight all the major trials that revolutionized rectal cancer management and improved oncologic outcomes. We present the origins of the trimodal therapy and the studies that supported the sequence of treatment. We describe the evolution in surgical management with total mesorectal excision as the standard of care, and we review the most impactful short- vs. long-course long-course radiation therapy trials. Today, the current standard of care for non-metastatic locally advanced rectal cancer includes preoperative chemoradiation with either induction or consolidation chemotherapy, total mesorectal excision and adjuvant therapy. We discuss the advent of the “watch and wait” strategy for patients who have a complete clinical response after total neoadjuvant treatment, as well as possible future directions in the treatment of locoregional disease.

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Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study

Cited by 68 publications

References 24 publications

A novel bowel rehabilitation programme after total mesorectal excision for rectal cancer: the BOREAL pilot study

A novel bowel rehabilitation programme after total mesorectal excision for rectal cancer: the BOREAL pilot study

Sequential assessment of bowel function and anorectal physiology after anterior resection for cancer: a prospective cohort study

The evolution of rectal cancer treatment: the journey to total neoadjuvant therapy and organ preservation

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