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

Buzatti, Kelly Cristine de Lacerda Rodrigues; Petroianu, Andy

doi:10.1590/0100-69912017004003

Cited by 13 publications

(10 citation statements)

References 37 publications

(35 reference statements)

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“…14 The Portuguese-validated version of the low anterior resection syndrome (LARS) score instrument was used to evaluate bowel function at least 4 weeks before and at 6 months and 1 year after surgery. 15,16 Data were prospectively collected. Due to medical amenorrhea, the LARS score was recorded off the menstrual phase.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Bowel Function After Surgical Treatment for Intestinal Endometriosis: A Prospective Study

Beraldo

Pellino

Ribeiro

et al. 2021

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Defecation symptoms related to intestinal deep infiltrative endometriosis are caused by anatomical and functional disorders and are probably linked to the course of the disease and surgical treatment. OBJECTIVE: The primary aim of this study was to assess bowel function before and after intestinal deep infiltrative endometriosis surgery. Secondarily, we sought to correlate defecatory symptoms with preoperative risk factors. DESIGN/SETTINGS: This is a single-center prospective cohort study, using the low anterior resection syndrome score to evaluate bowel function 4 weeks before, as well as at 6 months and 1 year after surgery. The Wilcoxon signed-rank test and logistic multiple regression analyses were performed to compare preoperative and postoperative scores. The level of significance was set at <0.05 for all comparisons. PATIENTS: Thirty-seven adult female patients who underwent intestinal resection for deep infiltrative endometriosis between 2015 and 2017 were included. MAIN OUTCOME MEASURES: The primary outcome was bowel function appraisement in deep infiltrative endometriosis intestinal surgery. RESULTS: During the preoperative evaluation, 48.6% of patients reported low anterior resection syndrome score ≥21. This group presented a mean score of 17.9 ± 13.7, with a median of 20 and a range of 5 to 30. After 1 year, the mean score was decreased to 9.6 ± 11.1, with a median of 4 and a range of 0 to 22. A significant difference was detected when comparing the post- and preoperative scores (p = 0.0006). Improvements in defecatory symptoms such as reduced fecal incontinence for flatus (p = 0.004) and liquid stools (p = 0.014) were also reported. The clustering of stools (p = 0.005) and fecal urgency (p = 0.001) also improved 1 year after surgery. The preoperative multiple logistic regression showed that dyschezia was the only independent variable associated with bowel symptoms. LIMITATIONS: This is a well-documented prospective study, but the data presented have a relatively small population. CONCLUSIONS: This study provides evidence that intestinal deep infiltrative endometriosis surgery improves bowel function and has a positive impact on evacuation symptoms. See Video Abstract at http://links.lww.com/DCR/B534. EVALUACIÓN DE LA FUNCIÓN INTESTINAL DESPUÉS DEL TRATAMIENTO QUIRÚRGICO PARA LA ENDOMETRIOSIS INTESTINAL: UN ESTUDIO PROSPECTIVO ANTECEDENTES: Se considera que los síntomas defecatorios relacionados con la endometriosis intestinal infiltrativa profunda, son causados por trastornos anatómicos y funcionales, y probablemente estén relacionados con el curso de la enfermedad y tratamiento quirúrgico. OBJETIVO: El objetivo principal fue evaluar la función intestinal antes y después de la cirugía por endometriosis intestinal infiltrativa profunda. En segundo lugar, correlacionar los síntomas defecatorios con los factores de riesgo preoperatorios. DISEÑO / AJUSTES: Es un estudio de cohorte prospectivo de un solo centro, utilizando la puntuación del síndrome de resección anterior baja (LARS Score) para evaluar la función intestinal 4 semanas antes, 6 meses y un año después de la cirugía. Se realizaron pruebas de rango firmado de Wilcoxon y análisis de regresión logística múltiple para comparar puntuaciones preoperatorias y postoperatorias. Para todas las comparaciones, el nivel de significancia se estableció en <0.05. ENTORNO CLINICO: Se incluyeron 37 mujeres adultas sometidas a resección intestinal por endometriosis infiltrativa profunda entre 2015 y 2017. PRINCIPALES MEDIDAS DE VALORACION: El resultado principal, fue la evaluación de la función intestinal en cirugía de endometriosis infiltrativa profunda intestinal. RESULTADOS: Durante la evaluación preoperatoria, el 48,6% de los pacientes reportaron Síndrome de Resección Anterior Baja ≥ 21. Este grupo presentó una puntuación media de 17,9 ± 13,7, con una mediana de 20 y un rango de 5 a 30. Después de un año, la puntuación media se redujo a 9,6 ± 11,1, con una mediana de 4 y un rango de 0 a 22 Se detectó una diferencia significativa al comparar las puntuaciones postoperatorias y preoperatorias (p = 0,0006). Se informó de mejoras en los síntomas defecatorios como la reducción de la incontinencia fecal por flatos (p = 0,004) y heces líquidas (p = 0,014). La agrupación de heces (p = 0,005) y la urgencia fecal (p = 0,001) presentaron mejoría a un año después de la cirugía. La regresión logística múltiple preoperatoria mostró que la disquecia fue la única variable independiente asociada con los síntomas intestinales. LIMITACIONES: A pesar de que es un estudio prospectivo bien documentado, los datos presentados son de una población relativamente pequeña. CONCLUSIONES: El estudio proporciona evidencia de que la cirugía intestinal por endometriosis infiltrativa profunda, mejora la función intestinal y tiene un impacto positivo en los síntomas de evacuación. Consulte Video Resumen en http://links.lww.com/DCR/B534.

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Section: Methodsmentioning

confidence: 99%

Evaluation of Bowel Function After Surgical Treatment for Intestinal Endometriosis: A Prospective Study

Beraldo

Pellino

Ribeiro

et al. 2021

Diseases of the Colon &Amp; Rectum

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“…After diverting stoma closure, the validated LARS score was applied in all patients and, when diagnosed as a minor or major LARS, a conservative treatment was proposed that included medical treatment and biofeedback therapy. 7,14 Patients who remained symptomatic were considered for transanal irrigation.…”

Section: Resultsmentioning

confidence: 99%

Feasibility Study of Transanal Irrigation Using a Colostomy Irrigation System in Patients With Low Anterior Resection Syndrome

Rodrigues

Buzatti

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Low anterior resection syndrome has a negative impact on quality of life. Intestinal irrigation is a method of lavage consisting of a scheduled evacuation.OBJECTIVE: This study aims to evaluate functional and quality-of-life outcomes in patients with low anterior resection syndrome after transanal irrigation using a colostomy irrigation system. DESIGN:This was a prospective case series. SETTINGS:This study presents a single-center experience at a tertiary oncological center in an upper-middleincome country.PATIENTS: Patients classified as having minor or major low anterior resection syndrome 12 months after their operation were selected. INTERVENTIONS:Transanal irrigation was performed using an ostomy irrigation kit. Questionnaires assessing patients' bowel function (low anterior resection syndrome and Wexner score) and quality of life (Short Form-36 questionnaire) were applied before and after treatment. MAIN OUTCOME MEASURES:The primary outcomes were low anterior resection syndrome score and quality-of-life improvement after a 12-month treatment. RESULTS:Of the 22 patients included, 20 had major and 2 had minor low anterior resection syndrome, with a median score of 39, especially high rates of incontinence for liquid stool (21; 95.5%), clustering (21; 95.5%), and urgency (17; 77.3%). All patients successfully completed the 3-day training, and there were no complications during the treatment. After the 12-month period, the median score was 8, with 90% of the patients classified as having "no syndrome" and great improvement in all domains of this score. The most improved quality-of-life sections were patient vitality (p = 0.025) and physical (p = 0.002), social (p = 0.001), and emotional aspects (p = 0.001). LIMITATIONS:The study was limited by its small sample size and the limited follow-up period. CONCLUSIONS:This study presents a safe implementation protocol of an ostomy irrigation device for transanal irrigation. It also adds to the literature that transanal irrigation is a safe, effective, and easily implemented procedure for patients with low anterior resection syndrome with a significant improvement in quality of life. See Video Abstract at http://links.lww. com/DCR/B563. ESTUDIO DE FACTIBILIDAD DE LA IRRIGACIÓN TRANSANAL UTILIZANDO EL SISTEMA DE IRRIGACIÓN PARA COLOSTOMÍA EN PACIENTES CON SÍNDROME DE RESECCIÓN ANTERIOR BAJAFunding/Support: Coloplast (São Paulo, Brazil) provided the ostomy irrigation kits used in the study. The company had no role in study design, data collection, analysis, interpretation, or decision to submit for publication.

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“…Reduction in sympathetic inhibitory action can, in turn, produce high amplitude propagated sequences (HAPS) leading to increased peristalsis of the colon (2,12,13). This can manifest as the increased gastrocolic reflex, urge to defaecate and loose stools (14).…”

Section: -Colonic Motilitymentioning

confidence: 99%

Low anterior resection syndrome (LARS)

Rajendra

2019

Sri Lanka j Surg

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Patients develop a variety of bowel dysfunction following low or very low anterior resection for rectal cancer. These symptoms are known collectively as low anterior resection syndrome (LARS), and the extent to which it affects the quality of life of these patients can be assessed by the LARS score. Knowledge about anorectal functional anatomy is a prerequisite to understanding the aetio-pathology and clinical manifestation of LARS. Structural and functional impairment of the internal and external anal sphincter and the anal transition zone, loss of reservoir function of the rectum, increased colonic motility, proximal diversion, enteric nervous system remodelling and neuropathy of autonomic nerves in the pelvis are known to cause LARS.Assessment of patients with LARS with MRI scan, endoanal ultrasound and anorectal manometry will help to identify the cause for LARS. Treatment of LARS will have to be tailored to the individual patient. The treatment protocol can start with conservative measures like pelvic floor rehabilitation, colonic irrigation and biofeedback therapy. Medication with Imodium and serotonin receptor antagonists may help some patients with LARS. Sacral nerve stimulation is a minimally invasive technique that has been used to treat patients with LARS for more than one year. Stoma creation will be considered in those with major LARS persisting for more than two years. Meticulous dissection with preservation of nerves and anal sphincters and anastomotic reconstruction techniques such as an end to side anal anastomosis or a colonic-J pouch anal anastomosis can minimize the occurrence of LARS. Introduction and definition of the low anterior resectionLow anterior resection for cancer is defined as the operation which aims to completely remove the rectum with its tumour, including total mesorectal excision, followed by anastomosis Correspondence: Sittampalam Rajendra

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

Cited by 13 publications

References 37 publications

Evaluation of Bowel Function After Surgical Treatment for Intestinal Endometriosis: A Prospective Study

Evaluation of Bowel Function After Surgical Treatment for Intestinal Endometriosis: A Prospective Study

Feasibility Study of Transanal Irrigation Using a Colostomy Irrigation System in Patients With Low Anterior Resection Syndrome

Low anterior resection syndrome (LARS)

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