Total mesorectal excision and sphincter preservation — the early steps of rectal cancer surgery

Perez, Rodrigo Oliva; Julião, Guilherme P. São; Proscurshim, Igor; Sabbagh, Charles; Grzona, Esteban; Lynn, Patricio B.; Gama-Rodrigues, J.

doi:10.1016/j.jcol.2013.12.007

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…In recently published data from a retrospective cross-sectional study from our group investigating bowel function after resection of low-lying rectal cancer, we found partial improvements in bowel function 1 year after ileostomy takedown, and patients who underwent follow-up before 1 year still experienced major bowel dysfunction [ 25 ]. Furthermore, Perez et al [ 26 ] reported similar findings of stabilized bowel function after the first year of follow-up.…”

Section: Discussionmentioning

confidence: 68%

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study

Sakr,

Yang,

Cho

et al. 2024

Ann Coloproctol

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Purpose: Despite advances in neoadjuvant chemoradiotherapy and anal sphincter-preserving surgery for rectal cancer, bowel dysfunction is still unavoidable and negatively affects patients’ quality of life. In this longitudinal study, we aimed to investigate the changes in bowel function with follow-up time and the effect of neoadjuvant chemoradiotherapy on bowel function following low anterior resection for rectal cancer.Methods: In this study, 171 patients with upper or middle rectal cancer who underwent low anterior resection between 2012 and 2018 were included. Bowel function was assessed longitudinally with Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores every 6 months after restoration of bowel continuity. Patients with at least 2 follow-up visits were included.Results: Overall, 100 patients received neoadjuvant chemoradiotherapy. Urgency, soilage, and fecal incontinence were noted within 24 months in the patients treated with neoadjuvant chemoradiotherapy. After 2 years of follow-up, significant bowel dysfunction and fecal incontinence were observed in the neoadjuvant chemoradiotherapy group. Low tumor level and neoadjuvant chemoradiotherapy were associated with delayed bowel dysfunction.Conclusion: Neoadjuvant chemoradiotherapy in combination with low tumor level was significantly associated with delayed bowel dysfunction even after 2 years of follow-up. Therefore, careful selection and discussion with patients are paramount.

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Section: Discussionmentioning

confidence: 68%

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study

Sakr,

Yang,

Cho

et al. 2024

Ann Coloproctol

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“…It has been reported that the symptoms of bowel dysfunction mostly occur during the first year after surgery and then become more stabilized as Perez et al reported. [ 82 ] In contrast, another study reported that 47.5% of patients still had LARS symptoms even after a follow-up period of 13.7 years. Moreover, one study reported major LARS in 46% of the patients with a mean follow-up of 14.6 years and this may be due to other associated risk factors.…”

Section: When Does Bowel Function Improve After Surgery?mentioning

confidence: 98%

Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer

Sakr

Sauri

Alessa

et al. 2020

Chinese Medical Journal

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Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients’ quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

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Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study

Sakr

Yang

Kang

et al. 2019

Journal of Surgical Oncology

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BackgroundDespite acceptable oncologic outcomes of sphincter preserving surgeries for low rectal cancer, bowel dysfunction occurs. This study aimed to compare the oncologic and functional bowel outcomes between ultralow anterior resection (ULAR) and intersphincteric resection (ISR) for low rectal cancer.MethodsOne hundred sixty‐four patients who underwent ULAR with or without ISR for low rectal cancer between December 2010 and May 2018 were included. The Wexner and Memorial Sloan Kettering Cancer Center (MSKCC) scores were used to evaluate the bowel function of patients. Overall survival (OS) and disease‐free survival (DFS) were compared between patients.ResultsThe ISR group had higher incidence of major fecal incontinence than the ULAR group (75.9% vs 49.3%; P = .016). The median Wexner score decreased from 12 to 9 (P = .062) at 1‐year follow‐up. However, the frequency and urgency/soilage subscales of MSKCC score improved significantly in the ULAR group. ISR and follow‐up interval less than 1‐year significantly increased the major incontinence risk. The OS in the ULAR and ISR groups was 91.4% and 91.7%. Whereas the DFS in both groups was 79% and 79.2%, respectively.ConclusionULAR and ISR are comparable in oncologic outcomes. Severe bowel dysfunctions and major incontinence were noted in ISR group. Careful selection of patients is mandatory.

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Total mesorectal excision and sphincter preservation — the early steps of rectal cancer surgery

Cited by 5 publications

References 22 publications

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study

Long-term bowel functional outcomes following anal sphincter-preserving surgery for upper and middle rectal cancer: a single-center longitudinal study

Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer

Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study

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