Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow‐up within the QoLiRECT study

Sandberg, Sofia; Asplund, Dan; Bisgaard, Thue; Bock, David; González, Elisabeth; Karlsson, Louise; Matthiessen, Peter; Ohlsson, Björn; Park, Jennifer; Rosenberg, Jacob; Skullman, S.; Sörensson, Marina Åkerblom; Angenete, Eva

doi:10.1111/codi.15095

Cited by 43 publications

(68 citation statements)

References 36 publications

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Section: Section Ii: Identifying Lars and Monitoring Of Treatmentmentioning

confidence: 99%

“…Furthermore, not all patients with a high LARS score consider themselves bothered by bowel dysfunction [28]. Younger patients are affected more often [28,35] and there are pronounced gender differences. Although the LARS score was developed with weight values of each item according to the impact on HRQoL, it does not include any HRQoL metric for the individual taking the score.…”

Section: Section Ii: Identifying Lars and Monitoring Of Treatmentmentioning

confidence: 99%

“…Although these are often reversible when chemotherapy is completed, it may contribute to chronic long‐term gastrointestinal symptoms. Neoadjuvant radiotherapy causes a more substantial impact on bowel function in most studies, even when confounding factors are removed [3,28]. Although modern radiotherapy with intensity‐modulated radiation therapy and volumetric‐modulated arc therapy aims to diminish the area receiving radiation, scatter to adjacent structures, such as the small bowel, pelvic organs or pelvic sidewalls and bony structures, still occurs.…”

Section: Section I: a Mixed Pathophysiological Model For Larsmentioning

confidence: 99%

“…Neoadjuvant radiotherapy for low rectal cancers is known to put patients at an increased risk of LARS when controlled for confounding factors [3,28]. It is imperative that oncological results are not compromised in terms of treatment.…”

Section: Section Iii: Prevention Of Larsmentioning

confidence: 99%

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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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Section: Section Ii: Identifying Lars and Monitoring Of Treatmentmentioning

confidence: 99%

Section: Section Ii: Identifying Lars and Monitoring Of Treatmentmentioning

confidence: 99%

Section: Section I: a Mixed Pathophysiological Model For Larsmentioning

confidence: 99%

Section: Section Iii: Prevention Of Larsmentioning

confidence: 99%

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Management guidelines for low anterior resection syndrome – the MANUEL project

et al. 2021

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“…However, so far there has been no report showing that the MSK‐BFI score improves over time. An analysis of LARS‐Q at different time points has not shown significant statistical variation over time [27,28].…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the Memorial Sloan Kettering Bowel Function Instrument and the Low Anterior Resection Syndrome Questionnaire for assessment of bowel dysfunction in rectal cancer patients after low anterior resection

et al. 2021

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Aim Neoadjuvant therapy and total mesorectal excision (TME) for rectal cancer are associated with bowel dysfunction symptoms known as low anterior resection syndrome (LARS). Our study compared the only two validated instruments—the LARS Questionnaire (LARS‐Q) and the Memorial Sloan Kettering Bowel Function Instrument (MSK‐BFI)—in rectal cancer patients undergoing sphincter‐preserving TME. Methods One hundred and ninety patients undergoing sphincter‐preserving TME for Stage I–III rectal cancer completed the MSK‐BFI and LARS‐Q simultaneously at a median time of 12 (range 1–43) months after restoration of bowel continuity. Associations between the MSK‐BFI total/subscale scores and the LARS‐Q score were investigated using Spearman rank correlation (r s). Discriminant validity for the two questionnaires was assessed, and the questionnaires were compared with the European Quality of Life Instrument. Results Major LARS was identified in 62% of patients. The median MSK‐BFI scores for no LARS, minor LARS and major LARS were 76.5, 70 and 57, respectively. We found a strong association between MSK‐BFI and LARS‐Q (r s −0.79). The urgency/soilage subscale (r s −0.7) and the frequency subscale (rs −0.68) of MSK‐BFI strongly correlated with LARS‐Q. Low correlation was observed between the MSK‐BFI diet subscale and LARS‐Q (r s −0.39). On multivariate analysis, both questionnaires showed worse bowel function in patients with distal tumours. A low to moderate correlation with the European Quality of Life Instrument was observed for both questionnaires. Conclusions The MSK‐BFI and LARS‐Q showed good correlation and similar discriminant validity. As the LARS‐Q is easier to complete, it may be considered the preferred tool to screen for bowel dysfunction.

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Long-term Quality of Life and Functional Outcome of Patients With Rectal Cancer Following a Watch-and-Wait Approach

et al. 2023

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ImportanceA watch-and-wait approach for patients with rectal cancer and a clinical complete response after neoadjuvant chemoradiotherapy or radiotherapy is associated with better quality of life and functional outcome. Nevertheless, prospective data on both parameters are scarce.ObjectiveTo prospectively evaluate quality of life and functional outcome, including bowel, urinary, and sexual function, of patients following a watch-and-wait approach.Design, Setting, and ParticipantsA total of 278 patients with rectal cancer and a clinical complete response or near-complete response after neoadjuvant chemoradiotherapy or radiotherapy were included in 2 prospective cohort studies: a single-center study (March 2014 to October 2017) and an ongoing multicenter study (from September 2017). Patients were observed by a watch-and-wait approach. Additional local excision or total mesorectal excision was performed for residual disease or regrowth. Data were analyzed between April 1, 2021, and August 27, 2021, for patients with a minimum follow-up of 24 months.Main Outcomes and MeasuresQuality of life was evaluated with the European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire–C30 (EORTC-QLQ-C30), EORTC-QLQ-CR38, or EORTC-QLQ-CR29 and 36-Item Short-Form Health Survey. The score for the questionnaires and 36-Item Short-Form Health Survey ranges from 0 to 100. For some scales, a high score indicates a high level of functioning, and for others it indicates a high level of complaints and symptomatology. Functional outcome was assessed by the Low Anterior Resection Syndrome score, Vaizey incontinence score, International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index.ResultsOf 278 patients included, 187 were male (67%), and the median age was 66 years (range, 34-85 years). In the first 24 months, 221 patients (80%) were observed by a watch-and-wait approach without requiring surgery, 18 patients (6%) underwent additional local excision, and 39 patients (14%) underwent total mesorectal excision. In general, patients observed by a watch-and-wait approach reported good quality of life, with limited variation over time. At 3 months, 56 of 221 patients (25.3%) reported major bowel dysfunction; at 12 months, 53 patients (24.0%) reported it; and at 24 months, 55 patients (24.9%) reported it. At 24 months, 48 of 151 male patients (31.8%) reported severe erectile dysfunction. For female patients, sexual satisfaction and overall sexual function decreased during follow-up. Patients who underwent local excision reported more major bowel dysfunction (10 of 18 patients [55.6%]) compared with those without additional surgery. Quality-of-life scores, however, were comparable. After total mesorectal excision, patients scored significantly worse on several quality-of-life subscales.Conclusions and RelevanceResults of this study suggest that patients with rectal cancer who were observed by a watch-and-wait approach had good quality of life, with some patients reporting bowel and sexual dysfunction. Quality of life and functional outcome deteriorated when patients required surgery. These data will be useful in daily care to counsel patients on what to expect from a watch-and-wait approach.

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Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow‐up within the QoLiRECT study

Cited by 43 publications

References 36 publications

Management guidelines for low anterior resection syndrome – the MANUEL project

Management guidelines for low anterior resection syndrome – the MANUEL project

Comparative analysis of the Memorial Sloan Kettering Bowel Function Instrument and the Low Anterior Resection Syndrome Questionnaire for assessment of bowel dysfunction in rectal cancer patients after low anterior resection

Long-term Quality of Life and Functional Outcome of Patients With Rectal Cancer Following a Watch-and-Wait Approach

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