Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study)

Ihnát, Peter; Slívová, Ivana; Tulinský, Lubomír; Rudinská, Lucia Ihnát; Máca, Jan; Penka, Igor

doi:10.1002/jso.24885

Cited by 43 publications

(49 citation statements)

References 34 publications

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“…Therefore, the need to evaluate LARS score occurs—several randomized controlled trials have demonstrated an almost 2-fold higher LARS prevalence in patients undergoing chemoradiotherapy with surgery compared to surgery alone ( 27 , 28 ). In a recent study by Ihnát et al ., authors compared LARS score following the surgery with or without radiotherapy and found that in the surgery alone group, 14.8% of the patients had major LARS and 37.0% of the patients had minor LARS compared to surgery plus radiotherapy group−53.6% of the patients with major LARS and 31.6% of the patients with minor LARS ( 29 ). In this study, the effect of chemoradiotherapy was not investigated, which could be added in future research.…”

Section: Discussionmentioning

confidence: 99%

Local Excision ± Chemoradiotherapy vs. Total Mesorectal Excision for Early Rectal Cancer: Case-Matched Analysis of Long-Term Results

et al. 2021

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Background: Our aim was to compare the bowel function and oncologic outcomes following these two treatment modalities.Materials and methods: This was a single-center study with 67 patients included between 2009 and 2018. A total of 32 patients underwent total mesorectal excision (TME) group and 35 transanal local excisions (LE) ± chemoradiation. We performed a case-matched analysis: we matched the patients by age, cancer stage, and comorbidities. Duration of operation, postoperative complications, length of hospital stay, and long-term functional and oncological outcomes were compared. We calculated oncological outcomes using Kaplan–Meier Cox diagrams. In addition, we used a low anterior resection syndrome (LARS) score for the bowel function assessment.Results: Mean operation time in the LE group was 58.8 ± 45 min compared with the TME group that was 121.1 ± 42 min (p = 0.032). Complications were seen in 5.7% in LE group and 15.62% in TME group (p = 0.043). ~85.2% of the patients had no LARS in LE group compared with 54.5% in TME group (p = 0.018). Minor LARS was 7.4% in LE group compared with 31.8% in TME group (p = 0.018); major LARS was 7.4 and 13.7%, respectively (p = 0.474). Hospital stay was 2.77 days in LE group compared with 9.21 days in TME group (p = 0.036). The overall survival was 68.78 months in LE group compared with 74.81 months in TME group (p = 0.964).Conclusion: Our results of a small sample size showed that local excision ± chemoradiation is a rather safe method for early rectal cancer compared with gold standard treatment. In addition, better bowel function is preserved with less postoperative complications and shorter hospital stays.

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Section: Discussionmentioning

confidence: 99%

Local Excision ± Chemoradiotherapy vs. Total Mesorectal Excision for Early Rectal Cancer: Case-Matched Analysis of Long-Term Results

et al. 2021

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“…Postoperative radiotherapy also causes deterioration of anal sphincter function [ 44 , 45 ]. The effect of radiotherapy is not only clinically significant, but also is visible in manometric studies [ 46 ]. Nevertheless, radiotherapy significantly improves overall survival and disease-free survival, and thus the elimination of this part of modern treatment is not possible [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome.

Nowakowski

Rubinkiewicz

Gajewska

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic surgery is an approved technique in colorectal cancer treatment. Functional and quality-of-life studies have revealed significant changes in faecal continence.AimTo assess the incidence and risk factors of low anterior resection syndrome (LARS) in patients undergoing rectal resections for cancer.Material and methodsWe enrolled patients undergoing rectal resections in a general surgery department of a university hospital. The primary outcomes were the Jorge-Wexner scale and the LARS score 6 months after the end of treatment. The secondary outcomes were the risk factors for LARS development.ResultsFifty-six patients were included; 15 (26%) developed major LARS and 10 (18%) had minor LARS at 6 months. In univariate analysis the risk factors were: preoperative radiotherapy (p < 0.001, OR = 11.9, 95% CI: 2.98–47.48); shorter distance of the tumour from the anal verge (p = 0.001, OR = 0.69, 95% CI: 0.55–0.86); bowel preparation (p = 0.01, OR = 6.27, 95% CI: 1.51–26.07); low anterior rectal resection (p = 0.01, OR = 17.07, 95% CI: 1.86–156.83); and protective ileostomy (p = 0.001, OR = 15.97, 95% CI: 4.07–61.92). The risk factors for a higher Jorge-Wexner score in univariate analysis were greater diameter of tumour (p = 0.035), radiotherapy (p = 0.001), shorter distance from the anal verge (p = 0.002), bowel preparation (p = 0.042), low anterior rectal (LAR) (p = 0.01), ileostomy (p = 0.001), perioperative complications (p = 0.032), and readmission within 30 days (p = 0.034). In the multivariate analysis, readmissions and perioperative complications were significant.ConclusionsIn addition to typically described risk factors, two new ones have been identified. Mechanical bowel preparation and defunctioning ileostomy may also contribute to LARS development. However, due to the limitations of this study our observations require further confirmation in future trials.

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“…Anorectal manometry may be useful [17,47,48] not as a diagnostic tool but to guide biofeedback therapy. It may help to quantify anal sphincter contraction and determine whether duration and/or amplitude should be targeted by the biofeedback.…”

Section: Section Iv: Recommended Work‐upmentioning

confidence: 99%

Management guidelines for low anterior resection syndrome – the MANUEL project

et al. 2021

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Aim Little is known about the pathophysiology of low anterior resection syndrome (LARS), and evidence concerning the management of patients diagnosed with this condition is scarce. The aim of the LARS Expert Advisory Panel was to develop practical guidance for healthcare professionals dealing with LARS. Method The ‘Management guidelines for low anterior resection syndrome’ (MANUEL) project was promoted by a team of eight experts in the assessment and management of patients with LARS. After a face‐to‐face meeting, a strategy was agreed to create a comprehensive, practical guide covering all aspects that were felt to be clinically relevant. Eight themes were decided upon and working groups established. Each working group generated a draft; these were collated by another collaborator into a manuscript, after a conference call. This was circulated among the collaborators, and it was revised following the comments received. A lay patient revised the manuscript, and contributed to a section containing a patient's perspective. The manuscript was again circulated and finalized. A final teleconference was held at the end of the project. Results The guidance covers all aspects of LARS management, from pathophysiology, to assessment and management. Given the lack of sound evidence and the often poor quality of the studies, most of the recommendations and conclusions are based on the opinions of the experts. Conclusions The MANUEL project provides an up‐to‐date practical summary of the available evidence concerning LARS, with useful directions for healthcare professional and patients suffering from this debilitating condition.

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Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study)

Abstract: RT significantly deteriorates the functional outcome of patients after LAR. Manometry revealed internal sphincter dysfunction, reduced capacity, and compliance of neorectum, which seem to have a significant correlation with LARS presence/seriousness.

Cited by 43 publications

References 34 publications

Local Excision ± Chemoradiotherapy vs. Total Mesorectal Excision for Early Rectal Cancer: Case-Matched Analysis of Long-Term Results

Local Excision ± Chemoradiotherapy vs. Total Mesorectal Excision for Early Rectal Cancer: Case-Matched Analysis of Long-Term Results

Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome.

Management guidelines for low anterior resection syndrome – the MANUEL project

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