Anterior resection syndrome: What should we tell practitioners and patients in 2018?

Sarcher, T.; Dupont, B.; Alvès, Arnaud; Menahem, Benjamin

doi:10.1016/j.jviscsurg.2018.03.006

Cited by 33 publications

(45 citation statements)

References 58 publications

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“…Low anterior resection syndrome (LARS) describes bowel dysfunction that is common after distal colorectal resection [1,2]. The pathophysiology is not clearly defined but is likely to be multifactorial [3,4]. Suspected contributing factors include pelvic nerve or sphincter injury, reduced compliance and sensation of the neorectum, and altered colonic motility [4–6].…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiology is not clearly defined but is likely to be multifactorial [3,4]. Suspected contributing factors include pelvic nerve or sphincter injury, reduced compliance and sensation of the neorectum, and altered colonic motility [4–6]. Therapeutic guidelines exist, but, without an understanding of the underlying mechanism to guide targeted treatment, patients are required to navigate various options using a trial and error approach.…”

Section: Introductionmentioning

confidence: 99%

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Altered colonic motility is associated with low anterior resection syndrome

et al. 2020

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Aim Patients frequently suffer from low anterior resection syndrome (LARS) after distal colorectal resection. The pathophysiology of LARS has not been clearly elucidated. We hypothesized that rectosigmoid resection could impair motility patterns in the distal colon, such as the rectosigmoid brake, which contribute to control of stool form and frequency. Method High‐resolution colonic manometry was performed in patients who had previously undergone distal colorectal resection (mean 6.8 years after resection) and non‐operative controls before and after a standardized meal. Symptoms were assessed using the LARS score. Propagating contractions were compared between patients with and without LARS, and controls. Results Data were analysed from 23 patients (11 no‐LARS; 12 LARS) and nine controls. All groups demonstrated a significant meal response. LARS patients had fewer post‐prandial antegrade propagating contractions than controls (P = 0.028), and fewer retrograde propagating contractions both pre‐ (P = 0.005) and post‐prandially (P = 0.004). Post‐prandially, the LARS group had a significantly lower percentage of propagating contractions that met the criteria for the cyclic motor pattern compared to the control group (26% vs. 58%; P = 0.009). There were significant differences in antegrade and retrograde amplitude (P = 0.049; P = 0.018) and distance of propagation (P = 0.003; P = 0.002) post‐prandially between LARS patients and controls. Conclusion Rectosigmoid resection alters the meal response following anterior resection, including impairment of the rectosigmoid brake cyclic motor pattern. These findings help to quantify the impaired functional motility after rectosigmoid resection and offer new insights into the mechanisms of LARS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Altered colonic motility is associated with low anterior resection syndrome

et al. 2020

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“…Up to 80% of patients with RC undergo SPS 5. The assessment of RC outcome has traditionally focused on morbidity rate, tumour recurrence and survival, while functional sequelae (ie, bowel and/or genitourinary impairment) have long been regarded as inherent to the nature of RC treatments 6 7. However, with improved surgical outcomes, we and others have observed a rising number of RC survivors who live with numerous potential side effects and, eventually, an impaired quality of life (QoL) 6–9.…”

Section: Introductionmentioning

confidence: 99%

‘French LARS score’: validation of the French version of the low anterior resection syndrome (LARS) score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients: a study protocol

et al. 2020

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IntroductionMany bowel problems following low anterior resection (LAR) for rectal cancer considerably impair the quality of life (QoL) of patients. The LAR syndrome (LARS) scale is a self-report questionnaire to identify and assess bowel dysfunction after rectal cancer surgery. It has been translated and validated in several languages but not in French (metropolitan French). The primary objective is to adapt the LARS scale to the French language (called French-LARS score) and to assess its psychometric properties. Secondary objectives are to assess both the prevalence and severity of LARS and to measure their impact on QoL.Methods and analysisA French multicentre observational cohort study has been designed. The validation study will include translation of the LARS scale following the current international recommendations, assessment of its reliability, convergent and discriminant validities, sensitivity, internal consistency, internal validity and confirmatory analyses. One thousand patients will be enrolled for the analyses. The questionnaire will be initially administered to the first 100 patients to verify the adequacy and degree of comprehension of the questions. Then reproducibility will be investigated by a test–retest procedure in the following 400 patients.An analysis will be conducted to determine the correlation between the LARS score and the Quality of Life Questionnaire (QLQ; European Organization for Treatment and Research of Cancer’s QLQ-C30, QLQ-CR29). Risk factors linked to QoL deterioration will be identified and their impact will be measured. This study will meet the need for a validated tool to improve patient care and QoL.Ethics and disseminationThe institutional review board of the University Hospital of Caen and the ethics committee (CPP Nord Ouest I, 25 January 2019) approved the study.Trial registration numberNCT03569488.

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“…It is primarily used in studies that investigate quality-of-life parameters related to the digestive system affected by this type of restorative surgery (6). There is increasing evidence that LARS has a detrimental impact on the quality of life, since a significant proportion of patients suffer from major LARS symptoms (7).…”

Section: Introductionmentioning

confidence: 99%