Variation in rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer

Abstract

Aim The aim was to evaluate the physiological variation in rectoanal inhibitory reflex (RAIR) after laparoscopic intersphincteric resection (Lap‐ISR) for ultralow rectal cancer. Method This was a retrospective study that included 56 patients who underwent Lap‐ISR from a prospectively collected database. The RAIR was examined preoperatively and up to 12 months after ileostomy closure. The primary outcome included physiological variation in RAIR and its difference between partial, subtotal and total ISR. The secondary outcome was its correlation with functional outcome. Results The reflex was present in 95% (53/56) of patients preoperatively, in 36% (20/56) before ileostomy closure, in 48% (27/56) at 3–6 months and in 61% (34/56) at 12 months after ileostomy closure. The elicited volume of RAIR was significantly increased at 12 months after ileostomy closure than at baseline (P = 0.005), but its duration and amplitude did not differ significantly. There was no significant difference in the reflex recovery between the ISR groups (partial vs. subtotal vs. total: 65% vs. 63% vs. 44%, P = 0.61). At 12 months after ileostomy closure, the RAIR‐present group had favourable functional results and patient satisfaction (P < 0.05). Major faecal incontinence was found in 82% of patients in the RAIR‐absent group. Conclusion The RAIR is abolished in the majority of patients after Lap‐ISR, but a time‐dependent recovery could be observed in more than half of the patients. The reflex recovery is not influenced by the resection grade of the internal sphincter. However, persistent loss of the RAIR correlates with worse continence.

Assessing Severity of Low Anterior Resection Syndrome After Intersphincteric Resection for Ultralow Rectal Cancer: A Pilot Study Using an Exploratory Instrument

“…The FIQL was adopted in this study in that it has a potentially higher sensitivity in monitoring QoL changes after ISR than health-related QoL questionnaires, as we reported more recently. 6 Our data showed significant improvements in domains of lifestyle and coping/ behavior, yielding an overall recovery of FIQL after ISR. Interestingly, the FIQL was strongly correlated with the Delphi consensus severity score but was weakly or moderately associated with the WIS and the LARS score.…”

“…[2][3][4] However, in terms of functional concerns, low anterior resection syndrome (LARS) development is virtually inevitable after ISR because of a multiple surgery-and patient-related factors. [5][6][7][8][9] The LARS score and the Wexner incontinence score (WIS) are frequently adopted as patient-reported outcome measures to evaluate bowel dysfunction after rectal surgery. Although both are quick evaluation tools, the former underestimates the impact of evacuatory dysfunction, and the latter focuses only on fecal incontinence.…”

“…2–4 However, in terms of functional concerns, low anterior resection syndrome (LARS) development is virtually inevitable after ISR because of a multiple surgery- and patient-related factors. 5–9…”

Is A Routine De-Functioning Stoma Benefit for Rectal Cancer Surgery: Results Basing On Meta-Analysis of Postoperative Complications and Quality of Life with A Stoma

“…However, the incidence of total complications increased. The incidence of total complications, containing bleeding, incisional hernia, abscesses, etc., may increase due to the surgery of both resection and stoma [50][51][52][53][54]. It should be noted that among 17 studies on postoperative complications included in this study, there were only 3 randomized controlled trials.…”

Quality of Life and Functional Outcomes After Intersphincteric Resection for Ultralow Rectal Cancer: A Prospective Observational Study

“…10,11 Previous studies have indicated that a high prevalence (60%–90%) of LARS maintains a long-term negative impact on QoL after LAR. 11 As far as ISR is concerned, it seems that LARS is an inevitable complication because of resection of the internal anal sphincter, 2 removal of the anal transition zone, 9 loss of the rectoanal inhibitory reflex, 12 and creation of a temporary diverting stoma, 11 all of which are considerable contributing factors for this complex syndrome. It is important to note that patients undergoing ISR report significantly worse incontinence symptoms than patients undergoing traditional LAR, 11 whereas the QoL outcomes remain controversial.…”