Low Anterior Resection Syndrome, A Predictable Complication?
Abstract
Introduction: Rectal cancer is the fifth most frequent neoplasm in both sexes in Portugal. With the evolution of preoperative imaging tests, surgical techniques and neoadjuvant therapy, anterior rectal resection (ARR) has become the gold standard in the treatment of this condition. Nevertheless, functional outcomes arise, namely the development of Low Anterior Resection Syndrome (LARS). It is defined as LARS major when the LARS SCORE is calculated and a value greater than 30 is obtained. This study aims to determine the incidence of LARS in patients undergoing ARR for rectal cancer treatment at the Centro Hospitalar de Setúbal and to identify LARS predictors.
Methods: A cohort retrospective study was conducted in rectal cancer patients electively undergoing ARR, from January 2019 to December 2020. The LARS diagnosis was made by applying the LARS score. Risk factors were assessed using the software SPSS® (Mann-Whitney U test and Chi-square test).
Results: The studied population consisted of 60 patients, of whom 32 (53.3%) had LARS, and 6 patients (6.6%) had major LARS. Low intestinal anastomosis ( <0.001) and ileostomy ( <0.001) were identified as statistically significant LARS predictors.
Conclusions: These results show that some clinical variables should be considered as predictive factors of LARS and need to be evaluated preoperatively when deciding which treatment to perform in each patient’s rectal cancer.
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References
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9. Martellucci J. Low Anterior Resection Syndrome: A Treatment Algorithm. Dis Colon Rectum. 2016;59(1):79-82. doi:10.1097/DCR.0000000000000495
10. Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13(9):e403-e408. doi:10.1016/S1470-2045(12)70236-X
11. van Duijvendijk P, van Tets WF, Boeckxstaens GEE. Prospective Evaluation of Anorectal Function After Total Mesorectal Excision for Rectal Carcinoma With or Without Preoperative Radiotherapy. 2002;97(9):8.
12. Rihttps H. The risk factors of low anterior resection syndrome after colorectal cancer surgery: A retrospective study of 566 patients in a single institution in China. Front Surg.:11.
13. Mekhael M, Kristensen HØ, Larsen HM, et al. Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review. J Clin Med. 2021;10(4):753. doi:10.3390/jcm10040753
14. Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, Sangkhathat S. Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients. Asian J Surg. 2016;39(4):225-231. doi:10.1016/j.asjsur.2015.07.003
15. Chen TYT, Wiltink LM, Nout RA, et al. Bowel Function 14 Years After Preoperative Short-Course Radiotherapy and Total Mesorectal Excision for Rectal Cancer: Report of a Multicenter Randomized Trial. Clin Colorectal Cancer. 2015;14(2):106-114.
16. Scheer AS, Boushey RP, Liang S, Doucette S, O’Connor AM, Moher D. The Long-term Gastrointestinal Functional Outcomes Following Curative Anterior Resection in Adults With Rectal Cancer: A Systematic Review and Meta-analysis. Dis Colon Rectum. 2011;54(12):1589-1597. doi:10.1097/DCR.0b013e3182214f11
2. Rama NJ, Ferreira PL, Pimentel J, Juul T, on behalf of the Portuguese PT LARS Collaborative Group. Validation of Portuguese version of the low anterior resection syndrome score. J Coloproctology. 2019;39(01):001-008. doi:10.1016/j.jcol.2018.09.004
3. Practice Parameters for the Management of Rectal Cancer (Revised). Dis Colon Rectum. 2005;48(3):411-423. doi:10.1007/s10350-004-0937-9
4. Jimenez-Gomez LM, Espin-Basany E, Trenti L, et al. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis. 2018;20(3):195-200. doi:10.1111/codi.13901
5. Sturiale A, Martellucci J, Zurli L, et al. Long-term functional follow-up after anterior rectal resection for cancer. Int J Colorectal Dis. 2017;32(1):83-88. doi:10.1007/s00384-016-2659-6
6. Marwan K, Staples MP, Thursfield V, Bell SW. The Rate of Abdominoperineal Resections for Rectal Cancer in the State of Victoria, Australia: A Population-Based Study. Dis Colon Rectum. 2010;53(12):1645-1651. doi:10.1007/DCR.0b013e3181f46485
7. Miacci FLC, Guetter CR, Moreira PH, et al. Síndrome da ressecção anterior do reto: fatores preditivos. Rev Colégio Bras Cir. 2019;46(6):e20192361. doi:10.1590/0100-6991e-20192361
8. Keane C, Wells C, O’Grady G, Bissett IP. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis. 2017;19(8):713-722. doi:10.1111/codi.13767
9. Martellucci J. Low Anterior Resection Syndrome: A Treatment Algorithm. Dis Colon Rectum. 2016;59(1):79-82. doi:10.1097/DCR.0000000000000495
10. Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13(9):e403-e408. doi:10.1016/S1470-2045(12)70236-X
11. van Duijvendijk P, van Tets WF, Boeckxstaens GEE. Prospective Evaluation of Anorectal Function After Total Mesorectal Excision for Rectal Carcinoma With or Without Preoperative Radiotherapy. 2002;97(9):8.
12. Rihttps H. The risk factors of low anterior resection syndrome after colorectal cancer surgery: A retrospective study of 566 patients in a single institution in China. Front Surg.:11.
13. Mekhael M, Kristensen HØ, Larsen HM, et al. Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review. J Clin Med. 2021;10(4):753. doi:10.3390/jcm10040753
14. Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, Sangkhathat S. Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients. Asian J Surg. 2016;39(4):225-231. doi:10.1016/j.asjsur.2015.07.003
15. Chen TYT, Wiltink LM, Nout RA, et al. Bowel Function 14 Years After Preoperative Short-Course Radiotherapy and Total Mesorectal Excision for Rectal Cancer: Report of a Multicenter Randomized Trial. Clin Colorectal Cancer. 2015;14(2):106-114.
16. Scheer AS, Boushey RP, Liang S, Doucette S, O’Connor AM, Moher D. The Long-term Gastrointestinal Functional Outcomes Following Curative Anterior Resection in Adults With Rectal Cancer: A Systematic Review and Meta-analysis. Dis Colon Rectum. 2011;54(12):1589-1597. doi:10.1097/DCR.0b013e3182214f11
Published
2024-07-29
How to Cite
AMADO, Fabíola et al.
Low Anterior Resection Syndrome, A Predictable Complication?.
Revista Portuguesa de Cirurgia, [S.l.], n. 57, p. 115-121, july 2024.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/1051>. Date accessed: 19 aug. 2024.
doi: https://doi.org/10.34635/rpc.1051.
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Section
Original Papers
