Rehabilitation program for patients with low anterior resection syndrome

Fomenko, O. Yu.; Кашников, В. Н.; Алексеев, М. В.; Веселов, А. В.; Белоусова, С. В.; Алешин, Д. В.; Morozov, Sergey; Козлов, В. А.; Reutova, A A; Rumiantsev, A S; Нафедзов, И. О.

doi:10.17116/kurort20209705152

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…Similarly, Fomenko et al [28] demonstrated the efficacy of a twostaged approach to managing LARS, using a combination of medical management with biofeedback followed by tibial nerve neuromodulation in 29 patients. Employing this approach, they were able to reduce overall LARS symptoms by almost half.…”

Section: Discussionmentioning

confidence: 98%

“…Pucciani et al [27] reported encouraging, preliminary results with complete resolution of LARS symptoms in a quarter of patients using a rehabilitation programme consisting of pelviperineal kinesitherapy, biofeedback, volumetric rehabilitation and electrostimulation. Similarly, Fomenko et al [28] demonstrated the efficacy of a two‐staged approach to managing LARS, using a combination of medical management with biofeedback followed by tibial nerve neuromodulation in 29 patients. Employing this approach, they were able to reduce overall LARS symptoms by almost half.…”

Section: Discussionmentioning

confidence: 99%

“…The LARS score is a well validated scoring system consisting of five questions, which was developed specifically for use in patients undergoing restorative rectal cancer surgery [19]. The score has a range of 0-42 points and stratifies patients into three categories: no LARS (0-20), minor LARS (20)(21)(22)(23)(24)(25)(26)(27)(28) or major LARS (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). The Wexner score consists of five questions and assesses three types of faecal incontinence (solid, liquid and gas) and their consequences (pad wearing and lifestyle alteration) [20].…”

Section: Outcome Measuresmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

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

et al. 2021

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“…The treatment of LARS requires long-term patient self-management, including behavior modification, dietary modification, pelvic floor rehabilitation, sacral nerve stimulation, and transanal irrigation. The efficacy of commonly used treatments is also dependent on patient implementation and requires an emphasis on patient education and follow-up [10].…”

Section: Discussionmentioning

confidence: 99%

“…These symptoms, which include altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation, have a negative impact on patients' quality of life [8], leading to anxiety, depression, social impairment, and social avoidance [9]. The literature suggests that 80% of patients undergoing SPS will develop LARS [10]. Among these patients, 25% have minor LARS [11], whereas 35-60% of patients have major LARS lasting for several years [12,13].…”

Section: Introductionmentioning

confidence: 99%

Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment

Zhang,

Luo,

Qiu

et al. 2023

Cancers

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Background: Low anterior resection syndrome (LARS) is a series of bowel dysfunction symptoms, including altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation. LARS occurs in 80% of patients undergoing sphincter-preserving surgery, affecting patients’ quality of life along with social avoidance. Different measurements and treatments have been raised to deal with LARS, but no systematic standard has been developed. Objective and Methods: To promote the standardization of clinical trials and clinical management of LARS, this review summarizes the latest findings up until 2023 regarding the diagnostic criteria, assessment protocols, and treatment modalities for postoperative LARS in rectal cancer. Results: The diagnostic criteria for LARS need to be updated to the definition proposed by the LARS International Collaborative Group, replacing the current application of the LARS score. In both clinical trials and clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire, the LARS score or MSKCC BFI, and at least one scale related to quality of life. Anorectal manometry, fecoflowmetry, endoscopic ultrasonography, and pelvic floor muscle strength testing are recommended to be adopted only in clinical trials. After analysis of the latest literature on LARS treatment, a stepwise classification model is established for the standardized clinical management of LARS. Patients with minor LARS can start with first-line treatment, including management of self-behavior with an emphasis on diet modification and medication. Lamosetron, colesevelam hydrochloride, and loperamide are common antidiarrheal agents. Second-line management indicates multi-mode pelvic floor rehabilitation and transanal irrigation. Patients with major LARS should select single or several treatments in second-line management. Refractory LARS can choose antegrade enema, neuromodulation, or colostomy. Conclusions: In clinical trials of LARS treatment between 2020 and 2022, the eligibility criteria and evaluation system have been variable. Therefore, it is urgent to create a standard for the diagnosis, assessment, and treatment of LARS. Failure to set placebos and differentiate subgroups are limitations of many current LARS studies. Randomized controlled trials comparing diverse therapies and long-term outcomes are absent, as well. Moreover, a new scale needs to be developed to incorporate the patient’s perspective and facilitate outpatient follow-up. Though the establishment of a stepwise classification model for LARS treatment here is indispensable, the refinement of the guidelines may be improved by more standardized studies.

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Medical rehabilitation in patients with anal incompetence after surgery for stage IV hemorrhoids

Fomenko

Фролов

Кашников

et al. 2022

Vopr. kurortol. fizioter. lech. fiz. kul't.

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Rehabilitation program for patients with low anterior resection syndrome

Cited by 7 publications

References 20 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

Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment

Medical rehabilitation in patients with anal incompetence after surgery for stage IV hemorrhoids

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