Functional results after treatment for rectal cancer

Abstract

Introduction With improving survival of rectal cancer, functional outcome has become increasingly important. Following sphincter-preserving resection many patients suffer from severe bowel dysfunction with an impact on quality of life (QoL) – referred to as low anterior resection syndrome (LARS). Study objective To provide an overview of the current knowledge of LARS regarding symptomatology, occurrence, risk factors, pathophysiology, evaluation instruments and treatment options. Results LARS is characterized by urgency, frequent bowel movements, emptying difficulties and incontinence, and occurs in up to 50-75% of patients on a long-term basis. Known risk factors are low anastomosis, use of radiotherapy, direct nerve injury and straight anastomosis. The pathophysiology seems to be multifactorial, with elements of anatomical, sensory and motility dysfunction. Use of validated instruments for evaluation of LARS is essential. Currently, there is a lack of evidence for treatment of LARS. Yet, transanal irrigation and sacral nerve stimulation are promising. Conclusion LARS is a common problem following sphincter-preserving resection. All patients should be informed about the risk of LARS before surgery, and routinely be screened for LARS postoperatively. Patients with severe LARS should be offered treatment in order to improve QoL. Future focus should be on the possibilities of non-resectional treatment in order to prevent LARS.

Long-term effects of neoadjuvant chemoradiotherapy followed by sphincter-preserving resection on anal sphincter function in relation to quality of life among locally advanced rectal cancer patients: a cross-sectional analysis

“…Data on the prevalence of incontinence and urgency aspects of bowel dysfunction following low anterior resection revealed large variations in different studies, ranging from 0 to 51 % and 4 to 68 % respectively [ 38 ]. Fecal incontinence is considered to be a common problem among patients with rectal cancer after surgery, recovered over time [ 39 – 41 ] in some patients, while as in our cohort it may also remain as a long-term problem in some patients with rectal cancer [ 5 ].…”

An Old Method Turnbull Cutait; Using for Middle and Distal Rectal Cancer Surgery without Ileostomy. Oncological and Fuctional Late Outcomes

“…It has been reported that the functional outcomes may have been worse after neoadjuvant radiotherapy. 16,18 In a 85 patient series of Sage et al 19 whom underwent T-C consecutively 71% good and very good functional outcome (Wexner score between 0-10), 29% poor functional outcome was reported. In our series, the por results in early stages showed improvement in time.…”

“…Studies have shown that up to 25 to 50% of all patients experience major dysfunction on a daily basis with a significant impact on quality of life. 16,17 The number of studies on functional outcomes after T-C is limited in the literature. It has been reported that the functional outcomes may have been worse after neoadjuvant radiotherapy.…”

Aspectos fisiopatológicos da síndrome pós-ressecção anterior do reto para o tratamento de câncer retal

“…Patients with LARS also present sensitivity diminishing of recto-anal transition, with prejudice to discriminate liquid and gas, affecting the rectoanal inhibitory reflex and the mechanisms of stool continence 11 . Change of rest anal pressure (internal anal sphincter -IAS) and maximum pressure of contraction (external anal sphincter -EAS) have been reported after ARR, causing soiling, and urgency and incontinence, respectively 12,14 . Ho et al 22 demonstrated that alterations of IAS may be related to introduction of instruments via anus (staplers) and to denervation during dissection and pelvic irradiation.…”

“…The group of functional alterations of intestine following ARR is known as low anterior resection syndrome -LARS 10,11 . LARS is characterized by a combination of symptoms, that include increase of stool movements, evacuation urgency, multiple evacuations and incontinence of flatus and stool, that may negatively impact on quality of life, in special social aspects of patients submitted to ARR [11][12][13][14] . In a study about this condition, Juul et al 15 evaluated 796 patients submitted to surgical treatment of rectal cancer and showed that quality of life following surgery is closely related to the severity of LARS symptoms.…”