The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer

Bohlok, Ali; Mercier, Camille; Bouazza, Fikri; Galdón, María Gómez; Moretti, Luigi; Donckier, Vincent; Nakadi, Issam El; Liberale, Gabriel

doi:10.1007/s00520-019-04901-2

Cited by 38 publications

(35 citation statements)

References 19 publications

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“…The influence of body mass index on the functional results of sphincter-preserving treatment was not confirmed in the process of meta-analysis. However, this factor was described as significant in some publications: for example, in the study by Bohlok et al [16], which included 43 patients after low anterior resection with a total mesorectal excision, 31 (72.1%) had signs of severe functional impairment, while BMI> 30 kg/m 2 was the only statistically significant risk factor for major LARS (p=0.047), which, nonetheless, could be detected due to a small sample size of patients in that study. Almost all authors of the studies included in our meta-analysis distinguished the factor of preventative ostomy as unfavorable in terms of functional results.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for major low anterior resection syndrome: meta-analysis and systematic literature review

et al. 2021

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Introduction — Low anterior resection syndrome (LARS) is a socially significant problem that impedes social adaptation and contributes to deterioration of life quality in patients. The objective of this study was to search for the category of patients most prone to major LARS, as well as to identify the factors determining the severity of this syndrome manifestations. Material and Methods — Systematic review and meta-analysis were performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study selected publications that included the functional results of treatment of patients operated for rectal cancer. Functional impairments were assessed according to the international LARS Score. Statistical analysis was performed using the inverse-variance weighted average method (IVW) with calculation of the odds ratio logarithm and standard error of the mean. Results — After a critical search and analysis of all literature sources, eight studies were found suitable for meta-analysis. In total, 1042 patients (796 men and 246 women) were included into statistical analysis, 409 of which (39.2%) had symptoms of major LARS. Chemotherapy was performed on 637 (62.5%) patients, while 568 subjects (55.5%) underwent radiation therapy, and anastomotic leaks were described in 89 (8.5%) people. According to the results of the meta-analysis, statistically significant factors were: preventative ostomy (OR=3.32, 95% CI 1.99-5.55, p<0.00001), chemotherapy (OR=1.98, 95% CI 1.23-3, 19, p=0.005), radiation therapy (OR=5.00, 95% CI 2.73-9.13, p <0.00001), anastomotic leaks (OR=2.93, 95% CI 2.30-3, 73, p<0.00001), anal verge distance from anastomosis site (OR=2.61, 95% CI 1.47-4.62, p=0.001). Conclusion — The results of our meta-analysis allowed us identifying the group of rectal cancer patients most vulnerable to LARS. The risk of developing severe functional disorders is significantly higher in patients with low colorectal anastomosis, as well as in patients undergoing neoadjuvant radiation therapy.

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Section: Discussionmentioning

confidence: 99%

Risk factors for major low anterior resection syndrome: meta-analysis and systematic literature review

et al. 2021

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“…Chen et al found that nearly half of the patients who underwent TME suffered from major LARS [34]. Bohlok et al (2019) also showed that a large proportion (72.1%) of patients after TME complained of LARS to different extents [35]. A meta-analysis done by Kidane et al also proposed the viewpoint that TEM could be adopted as a reliable device which provides similar oncological control but lower mortality rate [36].…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Chemoradiotherapy Versus Radical Surgery After Transanal Endoscopic Microsurgery for Intermediate Pathological Risk Early Rectal Cancer: a Single Center Experience With Long-term Surveillance

Qiu

Shi

et al. 2021

Preprint

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BackgroundThe choice of subsequent treatment for intermediate risk rectal tumors after Transanal endoscopic microsurgery (TEM) between adjuvant chemoradiotherapy and total mesorectal excision (TME) is controversial. The present study aimed to compare survival and functional outcome between these two strategies. Methods This retrospective study included intermediate risk early rectal cancer patients after TEM in our center between 2010 and 2017. Patients were divided into adjuvant treatment and TME groups. Intermediate risk was defined as pT1 with lymphovascular invasion, poor differentiation or large diameter (3-5 cm) or pT2 with small diameter(less than 3cm). The study was based on follow-up data on survival and results from distributed validated scales for functional outcome. ResultsPostoperative overall survival (OS) and disease-free survival (DFS) were comparable between groups (p = 0.619 and p = 0.712 respectively). Pathological T stage was an independent risk factor for DFS (HR 3.09, 95% CI 1.66 - 4.18, p = 0.044). Anorectal symptoms, such as buttock pain, was significantly prevalent in the TME group (p = 0.030). TME group presented with poorer bowel function, including stool urgency (p < 0.001), bowel frequency (p = 0.016), severity of LARS (p = 0.039) and total LARS score (p = 0.040). Except for a lower score of vaginal lubrication in TME group than the adjuvant treatment group, sexual function was similar between the groups. ConclusionLike TME, adjuvant chemoradiotherapy is an alternative option for intermediate risk early rectal cancer after TEM and is associated with similar survival outcomes and better bowel function.

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“…Opposingly, previous studies perceived female patients aged 50 to 79 to have a higher proportion of Major LARS and worse functional outcome, while age remains a subject of controversy between studies correlating young age to worse LARS scores and those not nding a signi cant correlation. [27][28][29][30] Postoperative bowel dysfunction is a major health issue and its burden on patients quality of life is sometimes underestimated [31]. In Arabic communities, such manifestations may also have a strong cultural component which not only increases the quality of life impediment [32], but also represents a hurdle to adequate care due to shame and miscommunication.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Moroccan arabic version of the low anterior resection syndrome score

Essangri¹,

Majbar²,

Benkabbou³

et al. 2020

Preprint

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Background: Sphincter sparing surgery is oftentimes associated with bowel dysfunction complaints, namely the low anterior resection syndrome (LARS). The LARS questionnaire is widely used to assess this syndrome. The aim of this observational study is to translate this tool into arabic and test its psychometric properties in rectal cancer patients, in order to ease its use in clinical practice and future research.Methods: The LARS questionnaire was translated to arabic and administered to a total of 143 patients. A subgroup of 42 patients took the test twice for test-retest reliability. Internal consistency was examined through cronbach’s alpha. The score results were correlated to the EORTC QLQ-C30 questionnaire for convergent validity assessment, while discriminant validity was established through the ability of the LARS score to differentiate patients with different clinical and pathological criteria.Results: The Moroccan Arabic version of the LARS score was completed by 143 patients. The internal consistency was demonstrated through a cronbach alpha score of 0.66. The agreement between the test and retest was established by a Bland Altman plot with 95% limits of agreement. 85.6% of patients remained in the same LARS category. The LARS score showed negative correlation with all five of the QLQ-C30 functional scales as well as positive correlation to the diarrhea symptom scale. The questionnaire score differed between patients according to their tumor location, chemoradiotherapy, type of mesorectal excision and anastomosis. Conclusion: The Moroccan Arabic version of the LARS score shows good psychometric properties and can be used for bowel dysfunction assessment in clinical and research settings.

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The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer

Abstract: Synopsis: Defecatory problems may occur after low anterior resection with total mesorectal excision. This study evaluated the incidence of these problems and their impact on quality of life in patients who underwent surgery for mid or low rectal cancer.

Cited by 38 publications

References 19 publications

Risk factors for major low anterior resection syndrome: meta-analysis and systematic literature review

Risk factors for major low anterior resection syndrome: meta-analysis and systematic literature review

Adjuvant Chemoradiotherapy Versus Radical Surgery After Transanal Endoscopic Microsurgery for Intermediate Pathological Risk Early Rectal Cancer: a Single Center Experience With Long-term Surveillance

Validation of the Moroccan arabic version of the low anterior resection syndrome score

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