Síndrome da ressecção anterior do reto: fatores preditivos.

Miacci, Fernanda Letícia Cavalcante; Guetter, Camila Roginski; Moreira, Paula Heroso; Sartor, Maria Cristina; Savio, Mariane Christina; Júnior, Antônio Baldin; Nóbrega, Norton Luiz

doi:10.1590/0100-6991e-20192361

Cited by 7 publications

(3 citation statements)

References 26 publications

(26 reference statements)

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“…В современной литературе имеется множество работ, описывающих более значимое влияние комбинированного лечения на сфинктерный аппарат прямой кишки по сравнению с оперативным вмешательством [13,20]. Операционная травма может вызвать нейрогенное повреждение запирательного аппарата за счет мобилизации особенно при низких резекциях прямой кишки [21].…”

Section: Discussionunclassified

Features of anorectal function after radiation therapy in patients with rectal cancer

Kit,

Bondarenko,

Gevorkyan

et al. 2024

jour

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Purpose of the study. To study the function of the sphincter in patients with rectal cancer after chemoradiotherapy using the method of high-resolution anorectal manometry.Materials and methods. The study included 30 patients with cancer of the middle and lower ampullary rectum, who underwent combined treatment at the National Medical Research Center of Oncology. The patients underwent a course of neoadjuvant gamma radiation therapy using capecitabine. High-resolution anorectal manometry was performed before the start of treatment and 2 months after completion of chemoradiotherapy to study the functional parameters of the sphincter apparatus. The severity of anorectal dysfunction was assessed using the Wexner anal incontinence scale.Results. According to high-resolution anorectal manometry, the average pressure of the anal canal at rest decreased by 1.4 times (p < 0.05), and the average absolute compression pressure with voluntary contraction decreased by 1.2 times (p = 0.0012) after neoadjuvant chemoradiotherapy. A comparative assessment of the maximum absolute compression pressure at this stage of treatment did not allow us to trace a significant difference between its value before the start of radiation therapy and 2 months after its completion (p > 0.05). An increase in threshold sensitivity volumes was noted in 23 patients (p = 0.16). The use of the Wexner scale didn’t show a statistically significant change in the median scores according to the results of patient surveys following the completion of treatment (5.2 vs. 5.5 points, p > 0.05).Conclusions. Radiation therapy has an effect on anorectal function, which may contribute to the occurrence of low anterior resection syndrome after surgical treatment. For this reason, it is now necessary to carefully consider the risks of developing anorectal dysfunction. Equally important is the use of methods for the prevention of low anterior resection syndrome for patients who have received combined treatment for rectal cancer.

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Section: Discussionunclassified

Features of anorectal function after radiation therapy in patients with rectal cancer

Kit,

Bondarenko,

Gevorkyan

et al. 2024

jour

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“…пороговое расстояние между колоректальным анастомозом и анальным краем, увеличивающее риск развития аноректальной дисфункции, составляет 6,5 см (p < 0,001). Изучение аноректальной функции с помощью шкалы LARS позволило выделить среди статистически значимых предикторов помимо уровня колоректального анастомоза (p < 0,001) так же и проведение лучевой терапии (р = 0,0014) и формирование илеостомы (р = 0,0023) [22]. В то же время такие изучаемые параметры, как пол, возраст, наличие вредных привычек, тип сформированного анастомоза не оказывали значимого влияния на развитие СНПР.…”

Section: методы оценки снпрunclassified

Low anterior resection syndrome and methods of its assessment (literature review)

Bondarenko,

Gevorkyan,

Soldatkina

et al. 2023

jour

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Low anterior resection syndrome is a common problem due to the increased incidence of rectal cancer and the high incidence of anorectal dysfunction during sphincter-preserving surgical interventions. The influence of functional disorders on the quality of life of patients and changes in social adaptation makes it possible to attribute the syndrome of low anterior resection to topical and discussed issues.Purpose of the study: to consider the features of the development of anorectal dysfunction in patients with rectal cancer by studying risk factors and pathogenetic aspects of the development of low anterior resection syndrome, as well as to evaluate the role of objective studies in assessing the syndrome according to published literature. The etiology of low anterior resection syndrome is multifactorial. Unmodified and modified predictors are distinguished among the risk factors. Unmodified factors include female gender and age over 65 years. Among the modifiable predictors, radiation therapy, surgical intervention, the type of formed colorectal anastomosis and the development of its insolvency, as well as the elimination of intestinal stoma have a negative effect on anorectal function. Nevertheless, the greatest role in its development is played by organ-preserving surgery with total mesorecumectomy, radiation therapy and the formation of a preventive ileostomy. The complexity of the pathophysiological mechanism of the syndrome necessitates a detailed study of anorectal function and changes in its parameters in patients during treatment for rectal cancer. Functional disorders in low anterior resection syndrome vary in severity. In the study of the severity of clinical manifestations of the syndrome, the use of the LARS scale is important, and in the development of anal incontinence, the use of the Wexner scale is important. However, the most accurate assessment can be carried out by objective research methods, such as high-resolution anorectal manometry. This research method allows to control the function of the rectal obturator apparatus at different stages of combined treatment and unwraps the possibility of searching for new predictors of low anterior resection syndrome.

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“…Low rectum resections are further associated with lifelong urinary and bowel disturbances [ 54 ] in 30% of cases, while sexual problems [ 55 ] affect up to 40% of patients. These functional complications are considered consequences of impaired reservoir function [ 56 , 57 ] and neural damage [ 58 ], respectively.…”

Section: Introductionmentioning

confidence: 99%

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain

Asencio,

Fins,

Mitie

et al. 2023

Clinics and Practice

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Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection (n = 33) for deep endometriosis in comparison with conservative excision (n = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile). The pain was evaluated with visual analogue scales. Linear excision and bowel resections improved FSFI, EHP 30, and postoperative pain comparably. By univariate analysis, a decreased sexual function was strongly associated with pain both before (p < 0.0001) and after surgery (p = 0.0012), age (p = 0.05), and duration of surgery (p = 0.023). By multivariate analysis (proc logistic), the FSFI after surgery was predicted only by FSFI before or EHP after surgery. No differences were found between low bowel segmental resection and a more conservative excision. In conclusion, improving pain after surgery can explain the improvement in sexual function. A deleterious effect of a bowel resection on sexual function was not observed for endometriosis. Sexual function in women with endometriosis can be evaluated using a simplified questionnaire such as FSFI-6.

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Síndrome da ressecção anterior do reto: fatores preditivos.

Cited by 7 publications

References 26 publications

Features of anorectal function after radiation therapy in patients with rectal cancer

Features of anorectal function after radiation therapy in patients with rectal cancer

Low anterior resection syndrome and methods of its assessment (literature review)

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain

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