Low Anterior Resection Syndrome Scores in Hand-Sewn vs Stapled Coloanal Anastomosis after Low-Rectal–Cancer Resection

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.

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High Risk of Low Anterior Resection Syndrome in Long-term Follow-up after Anastomotic Leakage in Anterior Resection for Rectal Cancer

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000002334 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Henrik Jutesten ◽

Pamela Buchwald ◽

Eva Angenete ◽

Martin Rutegård ◽

Marie-Louise Lydrup

Keyword(s):

Rectal Cancer ◽

High Risk ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome ◽

Long Term Follow Up

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

World Journal of Surgery ◽

10.1007/s00268-020-05876-6 ◽

2020 ◽

Cited By ~ 1

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.

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