Effect of Neoadjuvant Therapy on the Functional Outcome of Patients With Rectal Cancer: A Systematic Review and Meta-Analysis

Li, Xiangyuan; Fu, Rongrong; Ni, Haixiang; Du, Nannan; Wei, Mengfei; Zhang, Mengting; Shi, Yetan; He, Yujing; Du, Liwen

doi:10.1016/j.clon.2022.07.003

Cited by 9 publications

(5 citation statements)

References 91 publications

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“…However, neoadjuvant CCRT can also have side effects that may contribute to the development of LARS 33 . For example, radiation therapy can damage the nerves and muscles in the pelvic region, resulting in bowel dysfunction that might present as diarrhea, constipation, or rectal bleeding 34 . Chemotherapy can also cause changes in bowel function and may increase the risk of diarrhea, a common symptom of LARS 35 .…”

Section: Discussionmentioning

confidence: 99%

“…33 For example, radiation therapy can damage the nerves and muscles in the pelvic region, resulting in bowel dysfunction that might present as diarrhea, constipation, or rectal bleeding. 34 Chemotherapy can also cause changes in bowel function and may increase the risk of diarrhea, a common symptom of LARS. 35 Battersby et al 36 predicted bowel dysfunction severity before anterior resection using the nomogram method with various preoperative covariates, including age, tumor height, total versus partial mesorectal excision, stoma, and preoperative radiotherapy.…”

Section: Lars Syndromementioning

confidence: 99%

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Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery

Chiang,

Hsu,

Chern

et al. 2024

Cancer Medicine

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PurposeLow anterior resection syndrome (LARS) has had many impacts on the lives of patients and substantial differences in emotional and social functions. The aim of this study was to investigate the correlation analysis of different personality traits in rectal cancer patients with LARS after undergoing curative surgery.MethodsThis study was designed as a prospective cohort study. The inclusion criteria included (1) participants diagnosed with rectal cancer who underwent surgical resection of malignant tumors and (2) ECOG 0–1. The primary outcome was the correlation between different personality traits and low anterior resection syndrome in rectal cancer patients after radical surgery. Low anterior resection syndrome incidence rates were estimated by questionnaires and personality groups by the Type A and Type D Scale‐14 Personality Inventory.ResultsFor all 161 participants in this study, the presence of a tumor at the lower anal verge and the receipt of neoadjuvant CCRT had a statistically significant positive correlation with the LARS score at 1 month, 6 months, and 1 year (Pearson correlation coefficient = −0.283, −0.374, and − 0.205, respectively), with a p value of less than 0.05. Personalities with Type A, Type D, and Type D‐SI scores had a statistically significant positive correlation with LARS score at 1 month (Pearson correlation coefficient = 0.172, 0.162, and 0,164, p value = 0.03, 0.04, and 0.04).ConclusionType A and Type D personalities are highly linked to LARS. Personalized support approaches can ultimately assist rectal cancer patients in overcoming difficulties after surgery and recovery and enhance their functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Lars Syndromementioning

confidence: 99%

Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery

Chiang,

Hsu,

Chern

et al. 2024

Cancer Medicine

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“…Li et al conducted a meta-analysis in 2022, including 33 studies and involving 17,917 patients. The study concluded that neoadjuvant therapy emerged as an independent risk factor for the significant development of major LARS, with an odds ratio of 3.09 ( p < 0.001) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Low Anterior Resection Syndrome (LARS) after Surgery for Rectal Cancer: An Inevitable Price to Pay for Survival, or a Preventable Complication?

Muttillo,

La Franca,

Coppola

et al. 2023

JCM

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Background: Rectal cancer is frequent and often treated with sphincter-saving procedures that may cause LARS, a syndrome characterized by symptoms of bowel disfunction that may severely affect quality of life. LARS is common, but its pathogenesis is mostly unknown. The aim of this study is to assess the incidence of LARS and to identify potential risk factors. Methods: We performed an observational retrospective single center analysis. The following data were collected and analyzed for each patient: demographics, tumor-related data, and intra- and peri-operative data. Statistical analysis was conducted, including descriptive statistics and multivariate logistic regression to identify independent risk factors. Results: Total LARS incidence was 31%. Statistically significant differences were found in tumor distance from anal verge, tumor extension (pT and diameter) and tumor grading (G). Multivariate analysis identified tumor distance from anal verge and tumor extension as an independent predictive factor for both major and total LARS. Adjuvant therapy, although not significant at univariate analysis, was identified as an independent predictive factor. Time to stoma closure within 10 weeks seems to reduce incidence of major LARS. Conclusions:bold LARS affects a considerable portion of patients. This study identified potential predictive factors that could be useful to identify high risk patients for LARS.

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“…Tabchouri et al 29 reported that patients with rectal cancer receiving neoadjuvant CCRT had higher incidence rates of postoperative anastomotic leakage and sepsis. In addition, neoadjuvant radiation has been increasingly associated with postoperative bowel dysfunction, including low anterior resection syndrome 30 . Some postoperative patients with poor sphincter function may have a higher risk of PS formation.…”

Section: Discussionmentioning

confidence: 99%

Artificial intelligence based system for predicting permanent stoma after sphincter saving operations

Kuo,

Lin

2023

Sci Rep

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Although the goal of rectal cancer treatment is to restore gastrointestinal continuity, some patients with rectal cancer develop a permanent stoma (PS) after sphincter-saving operations. Although many studies have identified the risk factors and causes of PS, few have precisely predicted the probability of PS formation before surgery. To validate whether an artificial intelligence model can accurately predict PS formation in patients with rectal cancer after sphincter-saving operations. Patients with rectal cancer who underwent a sphincter-saving operation at Taipei Medical University Hospital between January 1, 2012, and December 31, 2021, were retrospectively included in this study. A machine learning technique was used to predict whether a PS would form after a sphincter-saving operation. We included 19 routinely available preoperative variables in the artificial intelligence analysis. To evaluate the efficiency of the model, 6 performance metrics were utilized: accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiving operating characteristic curve. In our classification pipeline, the data were randomly divided into a training set (80% of the data) and a validation set (20% of the data). The artificial intelligence models were trained using the training dataset, and their performance was evaluated using the validation dataset. Synthetic minority oversampling was used to solve the data imbalance. A total of 428 patients were included, and the PS rate was 13.6% (58/428) in the training set. The logistic regression (LR), Gaussian Naïve Bayes (GNB), Extreme Gradient Boosting (XGB), Gradient Boosting (GB), random forest, decision tree and light gradient boosting machine (LightGBM) algorithms were employed. The accuracies of the logistic regression (LR), Gaussian Naïve Bayes (GNB), Extreme Gradient Boosting (XGB), Gradient Boosting (GB), random forest (RF), decision tree (DT) and light gradient boosting machine (LightGBM) models were 70%, 76%, 89%, 93%, 95%, 79% and 93%, respectively. The area under the receiving operating characteristic curve values were 0.79 for the LR model, 0.84 for the GNB, 0.95 for the XGB, 0.95 for the GB, 0.99 for the RF model, 0.79 for the DT model and 0.98 for the LightGBM model. The key predictors that were identified were the distance of the lesion from the anal verge, clinical N stage, age, sex, American Society of Anesthesiologists score, and preoperative albumin and carcinoembryonic antigen levels. Integration of artificial intelligence with available preoperative data can potentially predict stoma outcomes after sphincter-saving operations. Our model exhibited excellent predictive ability and can improve the process of obtaining informed consent.

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Effect of Neoadjuvant Therapy on the Functional Outcome of Patients With Rectal Cancer: A Systematic Review and Meta-Analysis

Cited by 9 publications

References 91 publications

Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery

Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery

Low Anterior Resection Syndrome (LARS) after Surgery for Rectal Cancer: An Inevitable Price to Pay for Survival, or a Preventable Complication?

Artificial intelligence based system for predicting permanent stoma after sphincter saving operations

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