Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma

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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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 outcomes following laparoscopic total mesorectal excision for low rectal cancers: A clinical control study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2006.11.026 ◽

2007 ◽

Vol 33 (5) ◽

pp. 575-579 ◽

Cited By ~ 33

Author(s):

L. Yang ◽

Y.-Y. Yu ◽

Z.-G. Zhou ◽

Y. Li ◽

B. Xu ◽

...

Keyword(s):

Quality Of Life ◽

Total Mesorectal Excision ◽

Laparoscopic Total Mesorectal Excision ◽

Life Outcomes ◽

Mesorectal Excision ◽

Quality Of Life Outcomes ◽

Clinical Control ◽

Rectal Cancers ◽

Control Study

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The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study

BMC Geriatrics ◽

10.1186/s12877-020-02001-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amal Rhemouga ◽

Stefan Buettner ◽

Wolf O. Bechstein ◽

Guido Woeste ◽

Teresa Schreckenbach

Keyword(s):

Rectal Cancer ◽

Rectal Carcinoma ◽

Anterior Resection ◽

Low Anterior Resection ◽

Older Patients ◽

Retrospective Cohort ◽

Loop Ileostomy ◽

Linear Regression Analysis ◽

Multivariate Linear Regression Analysis ◽

Group B

Abstract Background Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Methods A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis. Results SCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68). Conclusion DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.

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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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Grading quality of total mesorectal excision specimen by surgeons

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v6i2.19806 ◽

2018 ◽

Vol 6 (2) ◽

pp. 69-73

Author(s):

Dhiresh Kumar Maharjan ◽

Prabin Bikram Thapa

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Anterior Resection ◽

College Teaching ◽

Mesorectal Excision ◽

Good Tool ◽

Photographic Documentation ◽

Photo Documentation ◽

Operating Surgeon

Background: Total mesorectal excision has been gold standard since 1978. But standardization of surgery with quality assurance of total mesorectal excision specimen has been a challenging issue in developing countries. However, quality of macroscopic total mesorectal excision can be graded immediately by operating surgeon before specimen has been fixed in formalin and photographic documentation of gross specimen by surgeons is possible and practical.Objective: To grade macroscopic total mesorectal excision specimen by surgeon and document it photographically and compare it with reporting received from pathologist. Methods: A prospective observational study conducted from Jan 2014 to Jan 2016 at Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. All consecutive patients with rectal cancer (upper/middle and lower) without distant metastasis were included. Immediate after surgery, macroscopic specimen of TME were graded by operating surgeon and photo-documentation with one anterior, one posterior and two right and left lateral views of total mesorectal excision photos were taken and documented with printed form along with operative notes.Results: There were 40 patients with rectal cancer who underwent surgery during this period. Among those patients, the median age was 25 years of which 30% were females. Twenty-four patients underwent low anterior resection whereas thirteen had ultralow anterior resection and three had abdominal perineal resection. All patients had photo documentation. Complete mesorectal excision was seen in 36 patients and four patients had near complete total mesorectal excision when graded by surgeons. However, pathologist reported six (16.6%) patients having near complete mesorectum among those which had been graded as complete by surgeons.Conclusion: Grading of macroscopic total mesorectal excision specimen by surgeon is feasible and with use of photographic documentation, it can help to assess the quality of surgeons work and can be a good tool for feedback for surgeons to improve.

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