Perioperative radiotherapy is an independent risk factor for major LARS: a cross-sectional observational study

Nuytens, Frederiek; Develtere, Dries; Sergeant, Gregory; Parmentier, Isabelle; D’Hoore, André; D’Hondt, Mathieu

doi:10.1007/s00384-018-3043-5

Cited by 19 publications

(22 citation statements)

References 25 publications

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“…Therefore, we resigned from presenting incomplete data in order to avoid bias due to different time of follow-up. We also did not analyse other types of surgery factors that may contribute to LARS development, for example, the type of radiotherapy [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

et al. 2018

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IntroductionDespite the progress in the treatment of colorectal cancer, there is still no optimal strategy for tumours located adjacent to the anal sphincter. This study aims to evaluate oncological and functional results of surgery for rectal cancer in unfavourable locations in proximity to anal sphincters.Materials and methodsPatients with rectal cancer, which was either initially infiltrating the anal sphincter or located in the close proximity of the sphincter, were included in the study. Patients were submitted to extralevator abdominoperineal resection (APR), intersphincteric resection, or transanal total mesorectal excision (TaTME). Primary outcomes were perioperative data: operative time, blood loss, complications, length of stay (LOS), and 30-day mortality. Secondary outcomes were pathological quality of the specimens and functional outcome 6 months after defunctioning ileostomy closure.ResultsAmong patients with cancer adjacent to the anal sphincter, 13 (25%) underwent APR, 14 (27%) patients were submitted to intersphincteric resection, and 25 (48%) patients were treated with the TaTME approach. Operative time was 240 (210–270 IQR) for APR, 212.5 (170–260 IQR) for intersphincteric resection, and 270 (240–330 IQR) for TaTME (p = 0.018). Perioperative morbidity was 31% for APR, 36% for intersphincteric resections, and 12% for the TaTME group (p = 0.181). Complete mesorectal excision was achieved in 92% of specimens in the TaTME group, 93% in intersphincteric resections, and 78% in the APR group (p = 0.72). Median circumferential resection margin in APR was 6 mm (4–7 IQR), in intersphincteric resections 7.5 mm (2.5–10 IQR), and in the TaTME group 4 mm (2.8–8 IQR). All patients after intersphincteric resections developed major low anterior resection syndrome (LARS). Four patients in the TaTME group developed minor LARS, and 21 had major LARS.ConclusionSphincter-saving rectal resections are a feasible alternative to APR with good clinical, pathological, and oncological outcomes. Intersphincteric resections and TaTME seem to be equal in terms of clinicopathological results. The functional outcome is yet to be investigated.Trial registrationThe study was retrospectively registered in Thai Clinical Trials Registry (23-07-2018, ID TCTR20180724001).

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Section: Discussionmentioning

confidence: 99%

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

et al. 2018

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“…Perioperative radiotherapy is a risk factor of faecal incontinence 6 months after the surgery. Other authors also identified neoadjuvant radiotherapy as a factor leading to LARS [ 26 , 42 , 43 ]. Postoperative radiotherapy also causes deterioration of anal sphincter function [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic technique resulted in a lower LARS score according to Nuytens et al [ 42 ]. In contrast, a meta-analysis performed by Lim et al showed no difference between minimally invasive and open approaches regarding sexual and bladder functions [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome.

Nowakowski

Rubinkiewicz

Gajewska

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic surgery is an approved technique in colorectal cancer treatment. Functional and quality-of-life studies have revealed significant changes in faecal continence.AimTo assess the incidence and risk factors of low anterior resection syndrome (LARS) in patients undergoing rectal resections for cancer.Material and methodsWe enrolled patients undergoing rectal resections in a general surgery department of a university hospital. The primary outcomes were the Jorge-Wexner scale and the LARS score 6 months after the end of treatment. The secondary outcomes were the risk factors for LARS development.ResultsFifty-six patients were included; 15 (26%) developed major LARS and 10 (18%) had minor LARS at 6 months. In univariate analysis the risk factors were: preoperative radiotherapy (p < 0.001, OR = 11.9, 95% CI: 2.98–47.48); shorter distance of the tumour from the anal verge (p = 0.001, OR = 0.69, 95% CI: 0.55–0.86); bowel preparation (p = 0.01, OR = 6.27, 95% CI: 1.51–26.07); low anterior rectal resection (p = 0.01, OR = 17.07, 95% CI: 1.86–156.83); and protective ileostomy (p = 0.001, OR = 15.97, 95% CI: 4.07–61.92). The risk factors for a higher Jorge-Wexner score in univariate analysis were greater diameter of tumour (p = 0.035), radiotherapy (p = 0.001), shorter distance from the anal verge (p = 0.002), bowel preparation (p = 0.042), low anterior rectal (LAR) (p = 0.01), ileostomy (p = 0.001), perioperative complications (p = 0.032), and readmission within 30 days (p = 0.034). In the multivariate analysis, readmissions and perioperative complications were significant.ConclusionsIn addition to typically described risk factors, two new ones have been identified. Mechanical bowel preparation and defunctioning ileostomy may also contribute to LARS development. However, due to the limitations of this study our observations require further confirmation in future trials.

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“…After LAR and colorectal anastomosis, patients often have increased stool frequency, urgency, stool fractionation and faecal incontinence. These symptoms are even more severe after neoadjuvant therapy, which is an independent risk factor for worse bowel function after LAR.…”

Section: Introductionmentioning

confidence: 99%

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Pucciarelli

Bianco

Pace

et al. 2019

British Journal of Surgery

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Background Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. Methods This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. Results Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. Conclusion Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov/).

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Perioperative radiotherapy is an independent risk factor for major LARS: a cross-sectional observational study

Abstract: Perioperative radiotherapy is an independent risk factor for major LARS. Fragmentation is considered the most disabling complaint in the majority of patients with major LARS. There is no significant adaptation of the LARS score over time.

Cited by 19 publications

References 25 publications

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome.

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

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