A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors

Croese, Alexander; Lonie, James; Trollope, Alexandra F.; Vangaveti, Venkat; Ho, Yik‐Hong

doi:10.1016/j.ijsu.2018.06.031

Cited by 222 publications

(224 citation statements)

References 26 publications

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“…Low anterior resection syndrome (LARS) was defined as a documented history of altered bowel symptoms affecting quality of life at least 12 months following index operation or stoma reversal. Symptoms used included incontinence of flatus and or faeces, urgency, stool clustering or fragmentation, diarrhoea or frequency …”

Section: Methodsmentioning

confidence: 99%

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

Ngoo

Tan

Mushaya

et al. 2020

ANZ Journal of Surgery

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Background: Rectal cancer treatment outcomes for socioeconomically disadvantaged and regional patients have been suggested to be suboptimal in Australia. We investigate outcomes at a regional tertiary centre in order to determine the prognostic impact of patient and treatment factors. Methods: Patients who underwent short and long course neoadjuvant therapy followed by surgery for stage II-III rectal cancer over an 11-year period were identified. Results were analysed to determine oncological and surgical outcomes along with whether patient and treatment-related variables were prognostic. Accessibility/Remoteness Index of Australia (ARIA) and Index of Relative Socioeconomic Disadvantage (IRSD) was used to determine remoteness and socioeconomic status, respectively. Results: A total of 207 patients underwent short (n = 103, 49.8%) and long course (n = 104, 50.2%) over the time period; 81.6% (n = 169) were from outer regional, remote or very remote communities and 55.1% travelled >200 km for treatment; 57.0% were in the most disadvantaged three IRSD deciles. Five-year cancer-specific survival, recurrence-free survival and local recurrence were 83.1% (n = 172), 76.3% (n = 158) and 7.3% (n = 15), respectively. Wound complications were higher in outer regional, remote or very remote patients (25.4% versus 13.2%, P = 0.03). Remoteness, socioeconomic indices, distance to treatment and neoadjuvant type were not prognostic for any other oncological or surgical outcomes on univariate or multivariate analysis. Conclusions: Despite demography suggesting geographic and socioeconomic barriers, oncological and surgical outcomes at our regional centre were comparable to international and Australian trials. Further, these factors were not prognostic. Geographically remote patient's may safely have neoadjuvant modality individualized without compromising care.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 812-820ANZJSurg.com

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Section: Methodsmentioning

confidence: 99%

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

Ngoo

Tan

Mushaya

et al. 2020

ANZ Journal of Surgery

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“…Development of a validated patient‐reported outcome measure, the LARS score, has improved standardization of reporting . Prevalence of LARS using this tool is reported to be 41% (95% confidence interval 34–48%) . The LARS score has good psychometric properties and has been validated in multiple languages .…”

Section: Introductionmentioning

confidence: 93%

“…12 Prevalence of LARS using this tool is reported to be 41% (95% confidence interval 34-48%). 13 The LARS score has good psychometric properties and has been validated in multiple languages. [14][15][16][17] However the LARS score may significantly underestimate the impact of evacuatory dysfunction and may not accurately assess the impact of symptoms on an individual patient's quality of life.…”

Section: Introductionmentioning

confidence: 99%

International consensus definition of low anterior resection syndrome

Keane

Fearnhead

Bordeianou

et al. 2020

ANZ Journal of Surgery

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Background Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. Methods This international patient‐provider initiative used an online Delphi survey, regional patient consultation meetings and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish and Danish). The primary outcome measured was the priorities for the definition of LARS. Results Three hundred and twenty‐five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. Conclusions This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.

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“…Pontallier et al 40 38 TaTME > 12 9 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 16 (42) 34 LapTME 10 (3-20) (P = 0⋅932) 14 (41) (P = 0⋅936) Kneist et al 41 10 TaTME Baseline…”

Section: Study Characteristics and Quality Controlmentioning

confidence: 99%

“…and †median (range). The International Prostate Symptom Score (IPSS) ranges from 0 to 35, with categories no/mild (0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) complaints. IIEF, International Index of Erectile Function; TaTME, transanal total mesorectal excision; n.r., not reported/not reported correctly; LapTME, laparoscopic total mesorectal excision.…”

Section: Faecal Incontinence Quality Of Life Scalementioning

confidence: 99%

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

Heijden

Köeter

Smits

et al. 2020

British Journal of Surgery

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Background Total mesorectal excision (TME) gives excellent oncological results in rectal cancer treatment, but patients may experience functional problems. A novel approach to performing TME is by single‐port transanal minimally invasive surgery. This systematic review evaluated the functional outcomes and quality of life after transanal and laparoscopic TME. Methods A comprehensive search in PubMed, the Cochrane Library, Embase and the trial registers was conducted in May 2019. PRISMA guidelines were used. Data for meta‐analysis were pooled using a random‐effects model. Results A total of 11 660 studies were identified, from which 14 studies and six conference abstracts involving 846 patients (599 transanal TME, 247 laparoscopic TME) were included. A substantial number of patients experienced functional problems consistent with low anterior resection syndrome (LARS). Meta‐analysis found no significant difference in major LARS between the two approaches (risk ratio 1·13, 95 per cent c.i. 0·94 to 1·35; P = 0·18). However, major heterogeneity was present in the studies together with poor reporting of functional baseline assessment. Conclusion No differences in function were observed between transanal and laparoscopic TME.

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A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors

Abstract: There is significant prevalence of Low Anterior Resection Syndrome following oncological rectal resection. A low anastomotic height or history of radiotherapy are major risk factors.

Cited by 222 publications

References 26 publications

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

International consensus definition of low anterior resection syndrome

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

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