Low anterior resection syndrome after surgical treatment of rectal cancer: Associated factors and correlation with the quality of life

Background/Aims: The low anterior resection syndrome (LARS) severely affects quality of life (QoL) after rectal cancer surgery. Studies investigating LARS and the effect on QoL after transanal endoscopic microsurgery (TEM) for rectal cancer are scarce. The aim of our study was to assess bowel dysfunction and QoL after TEM. Methods: Seventy-three patients who underwent TEM for stage I rectal cancer were included in this single-centre, cross-sectional study Bowel dysfunction was assessed by the LARS-Score, QoL by the European Organization for the Research and Treatment of Cancer QLQ-C30 and -CR29 questionnaires. Results: Fifty-five respondents (75.3%) could be included for the analyses. The median interval since treatment was 4.3 years, and the median age at the follow-up point was 72 years. “Major LARS” was observed in 29% of patients and “minor LARS” in 26%. Female gender (OR 4.00; 95% CI 1.20–13.36), neo-adjuvant chemoradiotherapy (OR 3.63; 95% CI 1.08–12.17) and specimen thickness in millimetres (OR 1.10 for each mm increase in thickness; 95% CI 1.01–1.20) were associated with the development of major LARS. Patients with major LARS fared worse in most QoL domains. Conclusion: This is the first study demonstrating major LARS after TEM treatment for rectal cancer, with a negative effect on QoL, even years after treatment. Our data provides an adequate counselling before TEM in terms of postoperative bowel dysfunction and its effect on QoL.

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Low anterior resection syndrome: impact on quality of life and nurse-led management

Gastrointestinal Nursing ◽

10.12968/gasn.2021.19.sup4a.s15 ◽

2021 ◽

Vol 19 (Sup4a) ◽

pp. S15-S20

Author(s):

Jennie Burch

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Surgical Removal ◽

Negative Consequences ◽

Management Options ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome

Rectal cancer is common and is often treated with surgical removal of the rectum, potentially including chemoradiation. Despite improvements in surgical technique, this treatment often results in long-term negative consequences. The most common of these symptoms involve bowel dysfunction, such as faecal incontinence, constipation and urgency, and are collectively termed low anterior resection syndrome (LARS). These often negatively impact on quality of life in a number of areas, including work, relationships and mental wellbeing. These symptoms can be eased with conservative management techniques, such as dietary modification, pelvic floor exercises and medication. If these are insufficient, patients can try specialist nurse-led interventions, including biofeedback, hypnotherapy, nerve stimulation and/or transanal irrigation. If these management options do not provide adequate quality of life, a permanent colostomy can be formed. It is important for nurses to recognise that problems can occur after treatment for rectal cancer and assist patients to overcome these problems and improve their quality of life.

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Validation of the Low Anterior Resection Syndrome Score in Finnish Patients: Preliminary Results on Quality of Life in Different Lars Severity Groups

Scandinavian Journal of Surgery ◽

10.1177/1457496920930142 ◽

2020 ◽

pp. 145749692093014

Author(s):

A. Carpelan ◽

E. Elamo ◽

J. Karvonen ◽

P. Varpe ◽

S. Elamo ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Life Questionnaire ◽

Mesorectal Excision ◽

Low Anterior Resection Syndrome ◽

European Organisation ◽

Anterior Resection Syndrome

Background and Aims: Low anterior resection syndrome is common after anterior resection for rectal cancer. Its severity can be tested with the low anterior resection syndrome score. We have translated the low anterior resection syndrome score to Finnish, and the aim of this study is to validate the translation. Materials and Methods: The translated Finnish low anterior resection syndrome score and European Organisation for Research and Treatment of Cancer quality-of-life questionnaire-C30 and QLQ-CR29 questionnaires were sent to 159 surviving patients operated with anterior resection for rectal adenocarcinoma between 2007 and 2014 in a tertiary referral center. Psychometric properties of the translation were evaluated in comparison to quality-of-life scales and in different risk factor groups. Results: In the study, 104 (65%) patients returned the questionnaires. Of these, 56 (54%) had major low anterior resection syndrome, 26 (25%) had minor low anterior resection syndrome, and 22 (21%) had no low anterior resection syndrome. Patients with major low anterior resection syndrome had a significantly lower quality of life and more defecatory symptoms as assessed with the European Organisation for Research and Treatment of Cancer questionnaires compared with those with no low anterior resection syndrome. Patients operated with total mesorectal excision had significantly higher low anterior resection syndrome scores compared with those operated with partial mesorectal excision (median/interquartile range 32/15 and 29/11, respectively, p = 0.037). The test–retest validity of the translation was good with an intraclass correlation coefficient of 0.77 (95% confidence interval 0.51–0.90). Conclusion: The Finnish low anterior resection syndrome score is a valid test in the assessment of postoperative bowel function and its impact on the quality of life. It can be implemented to use during regular follow-up visits of Finnish-speaking rectal cancer patients.

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Low Anterior Resection Syndrome and Quality of Life After Sphincter-Sparing Rectal Cancer Surgery

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000001228 ◽

2019 ◽

Vol 62 (1) ◽

pp. 14-20 ◽

Cited By ~ 19

Author(s):

Emil H.A. Pieniowski ◽

Gabriella J. Palmer ◽

Therese Juul ◽

Pernilla Lagergren ◽

Asif Johar ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome

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Relationships between Anxiety, Depression, Low Anterior Resection Syndrome, and Quality of Life Following Lower Anterior Resection for Rectal Cancer

Perspectives in Nursing Science ◽

10.16952/pns.2014.11.1.74 ◽

2014 ◽

Vol 11 (1) ◽

pp. 74 ◽

Cited By ~ 3

Author(s):

Eun Lee ◽

Keum Soon Kim

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome ◽

Anxiety Depression ◽

Lower Anterior Resection

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Two dominant patterns of low anterior resection syndrome and their effects on patients’ quality of life

Scientific Reports ◽

10.1038/s41598-021-82149-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min Jung Kim ◽

Ji Won Park ◽

Mi Ae Lee ◽

Han-Ki Lim ◽

Yoon-Hye Kwon ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Anterior Resection ◽

Low Anterior Resection ◽

University Hospital ◽

Postoperative Treatment ◽

Low Anterior Resection Syndrome ◽

Cross Sectional ◽

Anterior Resection Syndrome

AbstractTo identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504–43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504–43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100–4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

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Quality of life after rectal cancer surgery (systematic review)

Koloproktologia ◽

10.33878/2073-7556-2021-20-1-59-67 ◽

2021 ◽

Vol 20 (1) ◽

pp. 59-67

Author(s):

A. B. Serebriy ◽

E. A. Khomyakov ◽

I. O. Nafedzov ◽

O. Yu. Fomenko ◽

E. G. Rybakov

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Life Quality ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Low Anterior Resection Syndrome

Aim: search for modifiable and unmodifiable risk factors affecting the quality of life of patients after rectal cancer surgery.Materials and methods: the literature search was done according to the keywords: quality of life, rectal cancer, low anterior resection syndrome. Twelve prospective randomized studies, 2 cohort studies, and 2 meta-analyses are included in the study. The quality of life was assessed in the analyzed studies by using questionnaires for cancer patients and updated questionnaires for colorectal cancer: EORTC QLQ-CR29, QLQ-C30, QLQ-CR38, BIQ.Results: the literary data on influence of gender, age, surgery, stoma, and chemoradiotherapy on life quality of patients after rectal cancer surgery was analyzed.Conclusion: the most significant factor affecting the life quality of patients with rectal cancer is a violation of the body image if it is necessary to form the stoma on the anterior abdominal wall. The manifestations of the low anterior resection syndrome and the urination problems are significant risk factors in the case of restoration of bowel continuity.

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Low Anterior Resection Syndrome and Quality of Life

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000116 ◽

2014 ◽

Vol 57 (5) ◽

pp. 585-591 ◽

Cited By ~ 123

Author(s):

Therese Juul ◽

Madelene Ahlberg ◽

Sebastiano Biondo ◽

Eloy Espin ◽

Luis Miguel Jimenez ◽

...

Keyword(s):

Quality Of Life ◽

Anterior Resection ◽

Low Anterior Resection ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome

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Surgical correction of functional disorders in performing sphincterosafing operations for rectal cancer (literature review)

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj20174642-654 ◽

2017 ◽

Vol 25 (4) ◽

pp. 642-654

Author(s):

E. P. Kulikov ◽

Yu. D. Kaminsky ◽

S. V. Klevcova

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Malignant Tumors ◽

Functional Results ◽

Surgical Correction ◽

Low Anterior Resection Syndrome ◽

Cumulative Function

For many decades the main goal of oncologists was to increase life expectancy of patients with malignant tumors, without paying due attention to quality of life. Currently, the goals of patients’ treatment with rectal cancer are to cure, to minimize the risk of local recurrence, preserve the normal course of intestine, to optimize it's function and to ensure quality of life. For a long time, the standard surgical treatment of patients with low rectal cancer was abdominoperineal extirpation, but recently sphincterosafing operations have seen a widespread introduction in surgical practice. However, functional results after these types of operations don't always meet the expectations of surgeons and patients. In the postoperative period, patients often develop a syndrome of low anterior resection, characterized by frequent bowel movements, repeated, prolonged and incomplete evacuation of bowel and the imperative urge to defecate. The manifestation of this syndrome can significantly impair the quality of patient's life and reduce to nothing the efforts of the surgeon to preserve the sphincter of the rectum. For surgical correction of low anterior resection syndrome, various types of colonic reservoir anastomoses have been proposed. The purpose of formation of colonic reservoirs is to increase the cumulative function of intestine. However, the existing methods have several disadvantages related to technical complications and the risk of developing evacuation dysfunction, which is the reason for search the new ways of optimization of anastomoses when performing sphincterotomy operations for cancer of the rectum.

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