Prevalence of low anterior resection syndrome at a regional Australian centre

Croese, Alexander; Zubair, Omar; Lonie, James; Trollope, Alexandra F.; Vangaveti, Venkat; Mushaya, Chrispen; Ho, Yik‐Hong

doi:10.1111/ans.14749

Cited by 15 publications

(7 citation statements)

References 19 publications

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“…Our prevalence of LARS was similar between SC and LC (22.1% versus 19.1%, P = 0.70). This is consistent with the only two prospective studies to our knowledge which have directly compared neoadjuvant treatments . We would, however, note that wound complications were higher in patients from outer regional, remote or very remote communities (25.4% versus 13.2%, P = 0.03); in more remote areas post‐operative wound care often is performed by local health services or hospitals where expertise may vary …”

Section: Discussionsupporting

confidence: 87%

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

Ngoo

Tan

Mushaya

et al. 2020

ANZ Journal of Surgery

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Background: Rectal cancer treatment outcomes for socioeconomically disadvantaged and regional patients have been suggested to be suboptimal in Australia. We investigate outcomes at a regional tertiary centre in order to determine the prognostic impact of patient and treatment factors. Methods: Patients who underwent short and long course neoadjuvant therapy followed by surgery for stage II-III rectal cancer over an 11-year period were identified. Results were analysed to determine oncological and surgical outcomes along with whether patient and treatment-related variables were prognostic. Accessibility/Remoteness Index of Australia (ARIA) and Index of Relative Socioeconomic Disadvantage (IRSD) was used to determine remoteness and socioeconomic status, respectively. Results: A total of 207 patients underwent short (n = 103, 49.8%) and long course (n = 104, 50.2%) over the time period; 81.6% (n = 169) were from outer regional, remote or very remote communities and 55.1% travelled >200 km for treatment; 57.0% were in the most disadvantaged three IRSD deciles. Five-year cancer-specific survival, recurrence-free survival and local recurrence were 83.1% (n = 172), 76.3% (n = 158) and 7.3% (n = 15), respectively. Wound complications were higher in outer regional, remote or very remote patients (25.4% versus 13.2%, P = 0.03). Remoteness, socioeconomic indices, distance to treatment and neoadjuvant type were not prognostic for any other oncological or surgical outcomes on univariate or multivariate analysis. Conclusions: Despite demography suggesting geographic and socioeconomic barriers, oncological and surgical outcomes at our regional centre were comparable to international and Australian trials. Further, these factors were not prognostic. Geographically remote patient's may safely have neoadjuvant modality individualized without compromising care.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 812-820ANZJSurg.com

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Section: Discussionsupporting

confidence: 87%

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

Ngoo

Tan

Mushaya

et al. 2020

ANZ Journal of Surgery

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“…Sphincter-preserving rectal cancer surgery can avoid a permanent stoma, but 50%-90% of the patients are affected by varying degrees of neorectal dysfunction, commonly known as low anterior resection syndrome (LARS). 4 LARS encompasses a wide array of symptoms, including frequent bowel movements, faecal urgency, incomplete evacuation, incontinence and sexual or urinary dysfunctions. 5 These symptoms appear shortly after restoration of intestinal continuity.…”

Section: Introductionmentioning

confidence: 99%

A predictive nomogram model for low anterior resection syndrome after rectal cancer resection

Yan

Lin

et al. 2022

ANZ Journal of Surgery

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Background: The aim of this study was to identify risk factors associated with the low anterior resection syndrome (LARS) and to construct a nomogram capable of predicting the risk of LARS in patients who undergo rectal cancer resection. Methods: About 538 patients who had undergone anterior resection were recruited as a development set. In addition, 114 patients with rectal cancer were analysed as a validation set to test the new nomogram. Patients in the development set were grouped into two separate cohorts: those with major LARS and those with minor or no LARS. Multiple logistic regression was conducted to detect risk factors for major LARS. Results: The prevalence of major LARS was 40.7%, of minor LARS was 28.6% and the proportion with no LARS was 30.7% in the development set. In multivariate analysis, female gender, preoperative chemoradiation, low tumour height, diverting ileostomy, postoperative anastomotic leakage were shown to be independently associated with major LARS occurring in patients after rectal cancer resection. The area under the curve (AUC) values of the nomogram were 0.726 (95% CI: 0.682-0.769) and 0.750 (95% CI: 0.655-0.845) in the development and validation sets, respectively. The calibration curves and Hosmer-Lemeshow goodness of fit tests showed that the model was acceptably accurate. Conclusion: A nomogram model based on risk factors could be valuable as a predictor of the probability of major LARS after rectal cancer surgery, and provides a guide that clinical staff can use to take preventive measures for high-risk patients.

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“…The reported prevalence of major LARS, the most severe bowel dysfunction according to the LARS score, varies between 17·8 and 56·0 per cent 7,10–13 . A summary of the prevalence of LARS in previously reported studies 3,7,10,11,13–18 is presented in Table S1 (supporting information). Recently, the prevalence of LARS was investigated in a meta‐analysis 12 using the validated LARS score questionnaire, and the prevalence of major LARS was estimated to be 41 per cent based on 11 studies.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study

et al. 2020

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Background: The prevalence of major low anterior resection syndrome (LARS) after rectal cancer surgery varies from 17⋅8 to 56⋅0 per cent, but data from high-quality studies are sparse. The aim of this study was to determine the prevalence of LARS and its association with quality of life (QoL) in a large, well defined, population-based cohort. Methods: This was a population-based study that included all patients who had curative rectal cancer surgery with total or partial mesorectal excision in Stockholm County in Sweden between 2007 and 2013. Patients without a remaining stoma, free from cancer and alive in April 2017 were eligible for the study. The LARS score questionnaire, EORTC QLQ-C30 and Cleveland Clinic Florida Fecal Incontinence score were used as outcome measures. Adjusted mean scores (and differences) of EORTC QLQ-C30 for LARS groups were calculated using repeated measures ANCOVA regression models while adjusting for predefined confounders. Results: In total, 481 patients (82⋅6 per cent response rate) were included in the analysis. Mean follow-up time was 6⋅7 (range 3⋅4-11⋅0) years after surgery. The prevalence of LARS was 77⋅4 per cent (370 of 478 patients), with 53⋅1 per cent (254 of 478) experiencing major LARS. Patients with major LARS reported worse on all EORTC QLQ-C30 subscales (except for financial difficulties) than patients without LARS. A higher mean LARS score was associated with a greater impact on bowel-related QoL. Conclusion: After anterior resection for rectal cancer, the majority of patients suffer from major LARS with a negative impact on QoL.

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Prevalence of low anterior resection syndrome at a regional Australian centre

Abstract: The rate of major LARS at this regional centre is 37.5%. Larger prospective multicentre studies are required to determine impact of variables such as type of neoadjuvant therapy, anastomotic techniques and progression of LARS over time.

Cited by 15 publications

References 19 publications

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

A predictive nomogram model for low anterior resection syndrome after rectal cancer resection

Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study

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