The incidence and risk factors of low anterior resection syndrome (LARS) after sphincter-preserving surgery of rectal cancer: a systematic review and meta-analysis

Sun, Rui; Dai, Ziyi; Yin, Zhinan; Lu, Junliang; Zhang, Yuelun; Xiao, Yi

doi:10.1007/s00520-021-06326-2

Cited by 60 publications

(44 citation statements)

References 63 publications

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“…[23][24][25][26] It is known that the use of ileostomy is a risk factor for LARS. 27 Consistent with this finding, our result showed among the 16 patients undergoing ileostomy, 93.8% of cases had LARS (including 81.3% of minor LARS and 12.5% of major LARS). The mean number of defecations of the patients in this study exceeded 5 times/days.…”

Section: Discussionsupporting

confidence: 87%

Impact of defecation dysfunction on quality of life in mid-low rectal cancer patients following sphincter-sparing surgery

Luo¹,

Liu²,

Zhu

et al. 2022

Asia-Pacific Journal of Oncology Nursing

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Section: Discussionsupporting

confidence: 87%

Impact of defecation dysfunction on quality of life in mid-low rectal cancer patients following sphincter-sparing surgery

Luo¹,

Liu²,

Zhu

et al. 2022

Asia-Pacific Journal of Oncology Nursing

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“…Anastomotic height, 10,11,15,28–32 neoadjuvant radiotherapy, 33–35 and ileostomy, 33 have been consistently identified as risk factors for LARS using cross-sectional assessments in mainly non-controlled studies. Lower anastomotic height has also been shown to increase the severity of LARS at up to 36-months 36 .…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Radiotherapy, low anastomotic height, and stoma formation have been consistently established as risk factors for LARS in cross-sectional studies. [10][11][12][13] Despite increased recognition of LARS and its impact, little is known about the course of the symptomatology, as the literature is heavily reliant on cross-sectional assessments. Expert opinion suggests that bowel dysfunction is worst during the first 12 months after anterior resection after which time it improves.…”

mentioning

confidence: 99%

The Longitudinal Course of Low-anterior Resection Syndrome

et al. 2022

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Objective:We aimed to better understand the longitudinal course of low anterior resection syndrome (LARS) to guide patient expectations and identify those at risk of persisting dysfunction.Summary Background Data:LARS describes disordered bowel function after rectal resection that significantly impacts quality of life.Methods:MEDLINE, EMBASE, CENTRAL, and CINAHL databases were systematically searched for studies that enrolled adults undergoing anterior resection for rectal cancer and used the LARS score to assess bowel function at ≥2 postoperative time points. Regression analyses were performed on deidentified patient-level data to identify predictors of change in LARS score from baseline (3–6months) to 12-months and 18–24 months.Results:Eight studies with a total of 701 eligible patients were included. The mean LARS score improved over time, from 29.4 (95% confidence interval 28.6–30.1) at baseline to 16.6 at 36 months (95% confidence interval 14.2%–18.9%). On multivariable analysis, a greater improvement in mean LARS score between baseline and 12 months was associated with no ileostomy formation [mean difference (MD) –1.7 vs 1.7, P < 0.001], and presence of LARS (major vs minor vs no LARS) at baseline (MD –3.8 vs –1.7 vs 5.4, P < 0.001). Greater improvement in mean LARS score between baseline and 18–24 months was associated with partial mesorectal excision vs total mesorectal excision (MD–8.6 vs 1.5, P < 0.001) and presence of LARS (major vs minor vs no LARS) at baseline (MD –8.8 vs –5.3 vs 3.4, P < 0.001).Conclusions:LARS improves by 18 months postoperatively then remains stable for up to 3 years. Total mesorectal excision, neoadjuvant radiotherapy, and ileostomy formation negatively impact upon bowel function recovery.

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“…10 , 11 The increase in the rate of sphincter-preserving surgery means that more patients with rectal cancer will undergo anastomosis at a lower position, thus increasing the number of cases with anastomotic leakage accordingly. 12 , 13 There are many factors that cause anastomotic leakage after rectal cancer surgery, which are related to the patient’s physiological function, tumor growth, surgical technique, and postoperative management. 14 , 15 Preventing or reducing anastomotic leakage after rectal cancer surgery has always been the focus of surgeons.…”

Section: Discussionmentioning

confidence: 99%

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study

Zhang¹,

Hu²,

Qin³

et al. 2022

CMAR

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Purpose To determine an accurate method of inspecting low anastomotic leakages and application of transurethral prostate resection instrumentation for treating low rectal anastomotic leakage. Patients and Methods Clinical data of eight patients treated for anastomotic leakage after rectal cancer surgery at Zhangye People’s Hospital (affiliated to Hexi University), from August 2019 to November 2021, were retrospectively analyzed. Transanal prostate resection instrumentation was used to assess the leakage and surrounding conditions. Using prostate resection instrumentation, the presacral and perirectal residual cavities were washed and removed, and indwelling suprapubic presacral, transanal presacral, and rectal drainage tubes were placed. Continuous presacral saline irrigation and drainage and open negative-pressure suction in the rectal cavity were performed until the patients’ fistula healed. Results Of the eight patients with anastomotic leakages, one had grade B and seven had grade C International Study Group of Rectal Cancer anastomotic leakage classifications following Dixon operation. Transanal prostate resection instrumentation showed that the leakage of the one patient with grade B was less than a third of the circumference of the anastomosis. Among the seven patients with grade C, one leakage was less than a third of the anastomotic circumference. One patient had complete separation of the anastomosis and one distal colon necrosis, which necessitated immediate descending colostomy. Conservative treatment was successful in six patients; the conservative overall cure rate was 75%, and the median healing time was 43 (21–68) days. Conclusion Transanal examination of rectal anastomotic leakage using prostate resection instrumentation is comprehensive, easy to perform, provides clear visualization, accurately guides catheter placement, and can be combined with continuous open negative-pressure drainage, which is a safe, convenient, and effective method for treating low rectal leakage.

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The incidence and risk factors of low anterior resection syndrome (LARS) after sphincter-preserving surgery of rectal cancer: a systematic review and meta-analysis

Cited by 60 publications

References 63 publications

Impact of defecation dysfunction on quality of life in mid-low rectal cancer patients following sphincter-sparing surgery

Impact of defecation dysfunction on quality of life in mid-low rectal cancer patients following sphincter-sparing surgery

The Longitudinal Course of Low-anterior Resection Syndrome

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study

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