scholarly journals LARS is Associated with Lower Anastomoses, but not with the Transanal Approach in Patients Undergoing Rectal Cancer Resection

2020 ◽  
Author(s):  
Alexandra Filips ◽  
Tobias Haltmeier ◽  
Andreas Kohler ◽  
Daniel Candinas ◽  
Lukas Brügger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Regression Coefficient ◽  
Anal Verge ◽  
Transanal Approach ◽  
Cancer Resection ◽  
Rectal Cancer Resection ◽  
The Impact

Abstract Background Low anterior resection syndrome (LARS) is a defecation disorder that frequently occurs after a low anterior resection (LAR) with a total mesorectal excision (TME). The transanal (ta) TME for low rectal pathologies could potentially overcome some of the difficulties encountered with the abdominal approach in a narrow pelvis. However, the impact of the transanal approach on functional outcomes remains unknown. Here, we investigated the effect of the taTME approach on functional outcomes by comparing LARS scores between the LAR and taTME approaches in patients with colorectal cancer. Methods We conducted a retrospective cohort study including 80 patients (n = 40 LAR-TME, n = 40 taTME) with rectal adenocarcinoma. We reviewed medical charts to obtain LARS scores 6 months after the rectal resection or a reversal of the protective ileostomy. Results At the 6-month follow-up, 80% of patients exhibited LARS symptoms (44% minor LARS and 36% major LARS). LARS scores were not significantly associated with the T-stage, N-stage, or neo-adjuvant radiotherapy. The mean distance of the anastomosis from the anal verge was 4.0 ± 2.0 cm. The taTME group had significantly lower anastomoses compared with the LAR-TME group (median 4.0 cm [IQR1.8] vs. median 5.0 cm [IQR 2.0], p < 0.001). Univariable analysis revealed significantly higher LARS scores in the taTME group compared with the LAR-TME group (median LARS scores: 29 vs. 25, p = 0.040). However, multivariable regression analysis, adjusting for neo-adjuvant treatment, anastomosis distance from the anal verge, anastomotic leak rate, and body mass index, revealed no significant effect of taTME on the LARS score (adjusted regression coefficient:  − 2.147, 95%CI:  − 2.130 to 6.169, p = 0.359). We also found a significant correlation between LARS scores and the distance of the anastomosis from the anal verge (regression coefficient:  − 1.145, 95%CI:  − 2.149 to  − 1.141, p = 0.026). Conclusion Fifty percentage of patients in this cohort exhibited some LARS symptoms after a mid- or low-rectal cancer resection. As previously described, LARS scores were negatively correlated with the distance of the anastomosis from the anal verge. TaTME was after adjustment for the height of the anastomosis not associated with higher LARS at 6 months when compared with LAR-TME.

The impact of timing of stoma closure on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer

2021 ◽  
pp. 126-134
Author(s):  
Hemn Hussain Kaka Ali ◽  
Qalandar Hussein Abdulkarim ◽  
Karzan Seerwan ◽  
Barham M. M .Salih
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Loop Ileostomy ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Closure Of Ileostomy ◽  
The Mean ◽  
The Impact

This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus.  A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.    

scholarly journals Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Zhen Sun ◽  
Yufeng Zhao ◽  
Lu Liu ◽  
Jichao Qin
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Ileostomy Closure ◽  
Cancer Resection ◽  
Group Iii ◽  
Rectal Cancer Resection ◽  
Group I ◽  
Temporary Ileostomy

Background. The optimal timing of temporary ileostomy closure with respect to the time of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer remains unclear. The aim of this study is to investigate the clinical and oncological outcomes of ileostomy closure before, during, and after adjuvant chemotherapy following curative rectal cancer resection. Methods. Patients diagnosed with rectal adenocarcinoma who underwent low anterior resection and temporary loop ileostomy during May 2015 and September 2019 were retrospectively evaluated. Patients undergoing ileostomy closure before adjuvant chemotherapy (Group I) were compared to patients undergoing closure during (Group II) and after (Group III) adjuvant chemotherapy. Results. A total of 225 patients were evaluated for eligibility, and 132 were finally selected and divided into 3 groups (24 in Group I, 53 in Group II, and 55 in Group III). No significant differences were observed in operative time, postoperative hospital stay, postoperative complications, total adjuvant chemotherapy cycles, and low anterior resection syndrome scores among the three groups. There was no significant difference in disease-free survival ( p = 0.834 ) and overall survival ( p = 0.462 ) between the three groups. Conclusion. Temporary ileostomy closure before adjuvant chemotherapy following curative rectal cancer resection can achieve a clinical and oncological safety level equal to stoma closure during or after chemotherapy in selected patients.

OUTCOME OF SPHINCTER PRESERVING RECTAL RESECTION FOR LOW RECTAL CANCER

2017 ◽  
pp. 36-40
Author(s):  
Vinh Quy Truong ◽  
Anh Vu Pham ◽  
Quang Thuu Le
Keyword(s):  
Rectal Cancer ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Rectal Resection ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Central Hospital ◽  
Mesorectal Excision ◽  
Pull Through ◽  
Stage T1

Purpose: To evaluate the functional outcome of sphincter-preserving rectal resection for low rectal cancer. Materials and Methods: From April 2009 to January 2016, there are 52 patients who underwent sphincter-preserving rectal resection with total mesorectal excision with low rectal cancer (<6cm from the anal verge) at Hue Central Hospital, Hue, Vietnam. Results: the average age 62.7 ± 12.8, the distance of tumor from anal verge include four group (≤ 3cm 1.9%; 3 to ≤ 4cm 17.3%; 4 to ≤ 5cm 34.6%; > 5 cm). T stage T1/ T2/T3: 1.9%/28.8%/69.2%. The following time is 33.8 ± 18.9 month. Overall recurrence was 13/18(27.1%), local recurrence was 5 (10.4%). Total survival was 40.5 ± 2.9 month. Technique: intersphincteric preservation 14 (26.9%), low anterior resection 17 (32.7%) and pull-through procedure 21 (40.4%). The distance of anatomosis from anal verge: from 1 to ≤ 2 cm:14 (26.9%); from 2 to ≤ 3cm: 21 (40.4%); from 3 to ≤ 4 cm: 17 (32.7%). Bowels movement of 3 month: 4.7 ± 3.2 and 12th month: 2.7 ± 1.6 (p< 0.01). Conclusions: Sphincterpreserving rectal resection using may provide a good continence and oncologic safety. The patients are acceptable with the results of functional outcomes. Key words: Low rectal cancer, sphincter-preserving

scholarly journals Comparison between robotic-assisted and laparoscopic sphincter-preserving operations for ultra-low rectal cancer: a single institutional retrospective study

2021 ◽  
Author(s):  
Tadahiro Kojima ◽  
Hitoshi Hino ◽  
Akio Shiomi ◽  
Hiroyasu Kagawa ◽  
Yusuke Yamaoka ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Multivariate Analyses ◽  
Anal Verge ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery

Abstract Background Sphincter-preserving operations for ultra-low rectal cancer include low anterior resection and intersphincteric resection. In low anterior resection, the distal rectum is divided by a transabdominal approach, which is technically demanding. In intersphincteric resection, a perineal approach is performed. We aimed to evaluate whether robotic-assisted surgery is technically superior to laparoscopic surgery for ultra-low rectal cancer. The frequency of conducting low anterior resection by a specific procedure can indicate the technical superiority of that procedure for ultra-low rectal cancer. Thus, we compared the frequency of low anterior resection between robotic-assisted and laparoscopic surgery in cases of sphincter-preserving operations. Methods We investigated 183 patients who underwent sphincter-preserving robotic-assisted or laparoscopic surgery for ultra-low rectal cancer (lower border within 5 cm of the anal verge) between April 2010 and March 2020. The frequency of low anterior resection was compared between laparoscopic and robotic-assisted surgeries. The clinicopathological factors associated with an increase in performing low anterior resection were analyzed by multivariate analyses. Results Overall, 41 (22.4%) and 142 (77.6%) patients underwent laparoscopic and robotic-assisted surgery, respectively. Patient characteristics were similar between the groups. Low anterior resection was performed significantly more frequently in robotic-assisted surgery (67.6%) than in laparoscopic surgery (48.8%) (p = 0.04). Multivariate analyses showed that tumor distance from the anal verge (p < 0.01) and robotic-assisted surgery (p = 0.02) were significantly associated with an increase in the performance of low anterior resection. The rate of postoperative complications or pathological results was similar between the groups. Conclusions Compared with laparoscopic surgery, robotic-assisted surgery significantly increased the frequency of low anterior resection in sphincter-preserving operations for ultra-low rectal cancer. Robotic-assisted surgery has technical superiority over laparoscopic surgery for ultra-low rectal cancer treatment.

Revisiting the value of drains after low anterior resection for rectal cancer: An analysis of 996 patients.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 45-45
Author(s):  
Rachel M. Lee ◽  
Adriana C. Gamboa ◽  
Michael K. Turgeon ◽  
Sanjana Prasad ◽  
Gifty Kwakye ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leak ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Neoadjuvant Chemoradiation ◽  
Leak Rate ◽  
Intraabdominal Abscess ◽  
Anastomotic Leak Rate ◽  
Drain Placement

45 Background: Although potentially associated with increased infections, intraoperative pelvic drains are often placed during low anterior resection (LAR) to evacuate postoperative fluid collections and identify/control potential anastomotic leaks. Our aim was to assess the validity of this practice in a large dataset of patients undergoing LAR for rectal cancer. Methods: Patients from the US Rectal Cancer Consortium (2007-17) who underwent curative-intent LAR for a primary rectal cancer were included. Patients were categorized as receiving a closed suction drain intraoperatively or not. Primary outcomes were superficial surgical site infection(SSI), deep SSI, intraabdominal abscess, anastomotic leak, and need for secondary drain placement. Three subgroup analyses were conducted in patients who received neoadjuvant chemoradiation, had a diverting loop ileostomy (DLI), and had low tumors <6cm from the anal verge. Results: Of 996 pts, average age was 58 yrs, 61% were male, and 67% (n=551) received a drain. Drain patients were more likely to be male (64vs54%), have a smoking history (25vs19%), have received neoadjuvant chemoradiation (73vs61%), have low tumors within 6cm of the anal verge (56vs36%), and have received a DLI (80vs71%) (all p<0.05). Drains were associated with an increased anastomotic leak rate (14vs8%, p=0.041), although there was no difference in the need for a secondary drainage procedure to control the leak (82vs88%, p=0.924). These findings persisted in all subset analyses. Drains were not associated with increased superficial SSI, deep SSI, or intraabdominal abscess in the entire cohort or each subset analysis. Reoperation (12vs10%, p=0.478) and readmission rates (28vs31%, p=0.511) were similar. Conclusions: Although not associated with increased infectious complications, intraoperatively-placed pelvic drains after low anterior resection for rectal cancer are associated with an increase in anastomotic leak rate and no reduction in the need for secondary drain placement or reoperation. Routine drainage should be abandoned.

scholarly journals Robot-assisted low anterior resection after aluminum potassium sulfate and tannic acid sclerosing therapy for internal hemorrhoids

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Yoshiro Itatani ◽  
Tomoaki Okada ◽  
Kenji Kawada ◽  
Koya Hida ◽  
Nobu Oshima ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Tannic Acid ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Potassium Sulfate ◽  
Robot Assisted ◽  
Sclerosing Therapy ◽  
Double Stapling ◽  
Internal Hemorrhoids

Abstract Background Internal hemorrhoids are the most common anal diseases. Aluminum potassium sulfate and tannic acid (ALTA) injection is a new sclerosing therapy for the treatment of internal hemorrhoids. Although ALTA injection has been widely used, there are no previous reports of rectal cancer patients who underwent robot-assisted low anterior resection (Rob-LAR) after ALTA injection to treat internal hemorrhoids. Case presentation A 70-year-old man with rectal cancer was presented to our hospital. He had an ALTA injection 2 months before presentation at a clinic due to hematochezia with internal hemorrhoids. The rectal tumor was located 7 cm above the anal verge, and Rob-LAR with the da Vinci Xi system was performed. The patient had sclerosis on the stump of the anal side, which made it difficult to transect the rectum with linear staplers. This required multiple repeats of compression through the SmartClamp feedback. After anastomosis with the double-stapling technique, we constructed a diverting ileostomy. Conclusion Although ALTA injection is a promising strategy for internal hemorrhoids, rectal cancer should be excluded before the sclerosing therapy.

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