Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer

Jiménez-Gómez, Luís Miguel; Espín‐Basany, Eloy; Trenti, Loris; Martí-Gallostra, Marc; Sánchez-García, José Luis; Vallribera-Valls, Francesc; Kreisler, Esther; Biondo, Sebastiano; Armengol, Manel

doi:10.1111/codi.13901

Cited by 71 publications

(85 citation statements)

References 32 publications

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“…Several non-controlled studies 20,23,26 have shown an association between use of a temporary ileostomy and LARS. Only one-quarter of participants received radiotherapy, all tumours were above 5 cm and half were more than 10 cm above the anal verge.…”

Section: Discussionmentioning

confidence: 99%

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and 34 (28-39) respectively (Fig. The median LARS scores for the early and late closure groups were 31 (i.q.r.…”

Section: Low Anterior Resection Syndrome Scorementioning

confidence: 99%

“…59-75) and 63 (60-70) respectively; P = 0⋅207) or the frequency (22 (21)(22)(23)(24)(25) versus 22 (20)(21)(22)(23)(24); P = 0⋅437) and dietary (16 (13-18) versus 16 (12)(13)(14)(15)(16)(17)(18); P = 0⋅939) subscales (Fig. 59-75) and 63 (60-70) respectively; P = 0⋅207) or the frequency (22 (21)(22)(23)(24)(25) versus 22 (20)(21)(22)(23)(24); P = 0⋅437) and dietary (16 (13-18) versus 16 (12)(13)(14)(15)(16)(17)(18); P = 0⋅939) subscales (Fig.…”

Section: Memorial Sloan Ketting Cancer Center Bowel Function Instrumentmentioning

confidence: 99%

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Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Keane

Park

Öberg

et al. 2019

British Journal of Surgery

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Background Low anterior resection syndrome (LARS) has a significant impact on postoperative quality of life. Although early closure of an ileostomy is safe in selected patients, functional outcomes have not been investigated. The aim was to compare bowel function and the prevalence of LARS in patients who underwent early or late closure of an ileostomy after rectal resection for cancer. Methods Early closure (8–13 days) was compared with late closure (after 12 weeks) of the ileostomy following rectal cancer surgery in a multicentre RCT. Exclusion criteria were: signs of anastomotic leakage, diabetes mellitus, steroid treatment and postoperative complications. Bowel function was evaluated using the LARS score and the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI). Results Following index surgery, 112 participants were randomized (55 early closure, 57 late closure). Bowel function was evaluated at a median of 49 months after stoma closure. Eighty‐two of 93 eligible participants responded (12 had died and 7 had a permanent stoma). Rates of bowel dysfunction were higher in the late closure group, but this did not reach statistical significance (major LARS in 29 of 40 participants in late group and 25 of 42 in early group, P = 0·250; median BFI score 63 versus 71 respectively, P = 0·207). Participants in the late closure group had worse scores on the urgency/soiling subscale of the BFI (14 versus 17; P = 0·017). One participant in the early group and six in the late group had a permanent stoma ( P = 0·054). Conclusion Patients undergoing early stoma closure had fewer problems with soiling and fewer had a permanent stoma, although reduced LARS was not demonstrated in this cohort. Dedicated prospective studies are required to evaluate definitively the association between temporary ileostomy, LARS and timing of closure.

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Section: Discussionmentioning

confidence: 99%

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and 34 (28-39) respectively (Fig. The median LARS scores for the early and late closure groups were 31 (i.q.r.…”

Section: Low Anterior Resection Syndrome Scorementioning

confidence: 99%

Section: Memorial Sloan Ketting Cancer Center Bowel Function Instrumentmentioning

confidence: 99%

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Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Keane

Park

Öberg

et al. 2019

British Journal of Surgery

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“…A variety of risk factors for FI have been reported such as low rectal cancer, radiotherapy, and pelvic autonomic nerve damage [5][6][7]. In particular, the combination of a low-lying tumor and neoadjuvant radiotherapy significantly increases the likelihood of major bowel dysfunction [5,8].…”

Section: Introductionmentioning

confidence: 99%

Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

et al. 2020

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Background: Fecal incontinence frequently occurs after total mesorectal excision for rectal cancer. This prospective study analyzed predictive factors and the impact of pelvic intraoperative neuromonitoring at different follow-up intervals. Methods: Fifty-two patients were included undergoing total mesorectal excision for rectal cancer, and 29 under control of pelvic intraoperative neuromonitoring. Fecal incontinence was assessed using the Wexner Score at 3 and 6 months after stoma closure (follow-ups 1 and 2) as well as 1 and 2 years after surgery (follow-ups 3 and 4). Risk factors were identified by means of logistic regression. Results: New onset of fecal incontinence was significantly lower in the neuromonitoring group at each follow-up (follow-up 1: 2 of 29 patients (7%) vs. 8 of 23 (35%), (p = 0.014); follow-up 2: 3 of 29 (10%) vs. 9 of 23 (39%), (p = 0.017); follow-up 3: 5 of 29 (17%) vs. 11 of 23 (48%), p = 0.019; follow-up 4: 6 of 28 (21%) vs. 11 of 22 (50%), p = 0.035). Non-performance of neuromonitoring was found to be an independent predictor for fecal incontinence throughout the survey. Neoadjuvant chemoradiotherapy was an independent predictor in the further course 1 and 2 years after surgery. Conclusions: Performance of pelvic intraoperative neuromonitoring is associated with significantly lower rates of fecal incontinence. Neoadjuvant chemoradiotherapy was found to have negative late effects. This became evident 1 year after surgery.

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“…Postoperative major LAR syndrome was found to be independently associated with a complete TME, preoperative radiotherapy, and postoperative radiotherapy. 48…”

Section: Anatomy Physiology and Etiologymentioning

confidence: 99%

Overlooked Long-Term Complications of Colorectal Surgery

Giglia

Stein

2019

Clinics in Colon and Rectal Surgery

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While colorectal surgery has been documented to have some of the highest complication rates in the surgical field, some of the more common, functional complications are often overlooked in the literature and in discussion with patients. Urinary, sexual, and defecatory dysfunction are common after colorectal surgery, especially after pelvic dissections, and may severely impact the postoperative quality of life for patients. These complications include urinary retention, erectile dysfunction, retrograde ejaculation, dyspareunia, infertility, and low anterior resection syndrome. The majority is rooted in autonomic nerve damage, both sympathetic and parasympathetic, that occurs during mobilization and resection of the sigmoid colon and rectum. While not all of these postoperative complications are preventable, treatment strategies have been developed to ameliorate the impact on quality of life. Given the high incidence and direct effect on patients, clinicians should be familiar with the etiology, prevention, and treatment strategies of these complications to provide the highest quality of care.

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Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer

Abstract: In this study, the risk of having major LARS increases with total mesorectal excision and both neoadjuvant and adjuvant radiotherapy. This article is protected by copyright. All rights reserved.

Cited by 71 publications

References 32 publications

Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

Overlooked Long-Term Complications of Colorectal Surgery

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