Anterior Resection Syndrome Research Articles

Low Anterior Resection Syndrome following Restorative Proctectomy for Rectal Cancer: Can the Surgeon Have Any Meaningful Impact?

Postoperative bowel dysfunction following restorative proctectomy, commonly referred to as Low Anterior Resection Syndrome (LARS), is a common long term sequela of rectal cancer treatment. While many of the established risk factors for LARS are non-modifiable, others may be well within the surgeon's control. Several pre-, intra-, and postoperative decisions may have a significant impact on postoperative bowel function. Some of these factors include the extent of surgical resection, surgical approach, choice of anastomotic reconstruction, and use of fecal diversion. This review article summarizes the available evidence regarding how surgical decision-making can affect postoperative bowel function.

The impact of anastomotic leakage on the quality of life of patients after surgery for rectal cancer

AIM: to assess the impact of colorectal anastomotic leakage on the severity of low anterior rectal resection syndrome and the quality of life.PATIENTS AND METHODS: the results of 375 patients with rectal tumors were analyzed. In 26 patients, surgery was complicated by anastomosis failure. For a assessment of the quality of life of patients with anastomotic leakage, each patient was matched with a pair from the group of respondents with an uncomplicated postoperative period. The quality of life was assessed in all patients using the EORTC QLQ-C30 questionnaire with the Cr-29 module.RESULTS: patients with anastomosis leakage have more severe low anterior rectal resection syndrome — 29 (17;34), versus 20 (9;28) points (p = 0.03) and a lower global score (p = 0.01), physical (p = 0.01) and social (p = 0.04) functioning. The symptom scales of the EORTC QLQ-C30 questionnaire, supplemented by the Cr-29 module, had significant differences between groups on the scales of body image (p = 0.01), fecal incontinence (p = 0.04) and embarrassment (p = 0.01).CONCLUSION: colorectal anastomosis leakage negatively affects the quality of life of patients.

Implementation of Pelvic Floor Rehabilitation after rectal cancer surgery: A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR).

Pelvic Floor Rehabilitation (PFR) is effective in a selection of patients with low anterior resection syndrome (LARS) after rectal cancer surgery. This study aimed to identify barriers and enablers to prepare for successful implementation into clinical practice. A qualitative study was performed, guided by the Consolidated Framework for Implementation Research (CFIR). Individual interviews (n = 27) and two focus groups were conducted to synthesize the perspectives of rectal cancer patients, pelvic floor (PF) physiotherapists, and medical experts. Barriers were found to be the absence of guidelines about LARS treatment, underdeveloped network care, suboptimal patient information, and expectation management upfront to PFR. Financial status is frequently a barrier because insurance companies do not always reimburse PFR. Enablers were the current level of evidence for PFR, the positive relationship between patients and PF physiotherapists, and the level of self-motivation by patients. The factors identified in our study play a crucial role in ensuring a successful implementation of PFR after rectal cancer surgery.

Bowel Dysfunction After Colon Cancer Surgery: A Prospective, Longitudinal, Multicenter Study.

Longitudinal studies on functional outcomes after colon resection are limited. To evaluate bowel dysfunction and related distress 1 and 3 years after colon resection using the low anterior resection syndrome score as well as specific validated items. This study presents the long-term results of bowel dysfunction and related distress based on the Quality of Life in Colon Cancer study, an observational, prospective multicenter study of patients with newly diagnosed colon cancer. The study was conducted at 21 Swedish and Danish surgical centers between 2015 and 2019. All patients who underwent right-sided or left-sided colon resection were considered eligible. Exclusion criteria were age younger than 18 years, cognitive impairment, or inability to understand Swedish/Danish. Patients completed extensive questionnaires at diagnosis and after 1 and 3 years. Clinical data were supplemented by national quality registries. The low anterior resection syndrome score, specific bowel symptoms, and patient-reported distress were assessed. Of 1221 patients (83% response rate), 17% reported major low anterior resection syndrome 1 year after either type of resection; this finding was consistent at 3 years (17% right, 16% left). In the long-term, the only significant difference between types of resections was a high occurrence of loose stools after right-sided resections. Overall, less than one-fifth of patients experienced distress, with women reporting more frequent symptoms and greater distress. In particular, incontinence and loose stools correlated strongly with distress. Absence of prediagnosis bowel function data. Our study indicates that bowel function remains largely intact after colon resection, with only a minority reporting significant distress. Adverse outcomes were more common among women. The occurrence of loose stools after right-sided resection and the association between incontinence, loose stools, and distress highlights a need for postoperative evaluations and more thorough assessments beyond the low anterior resection syndrome score when evaluating patients with colon cancer. See the Video Abstract . ANTECEDENTES:Los estudios longitudinales sobre el resultado funcional después de una resección cólica son limitados.OBJETIVO:Examinar la disfunción intestinal y el malestar relacionado uno y tres años después de la resección del colon utilizando la puntuación de referencia en el síndrome de resección anterior baja (LARS), así como otros ítems de validez específica.DISEÑO:Este estudio presenta los resultados a largo plazo de la disfunción intestinal y la angustia relacionada según el estudio QoLiCOL (Quality of Life in COLon cancer), un analisis observacional, prospectivo y multicéntrico de pacientes con cáncer de colon recién diagnosticado.AJUSTES:El presente estudio fué realizado en 21 centros quirúrgicos suecos y daneses entre 2015 y 2019.PACIENTES:Todos los pacientes sometidos a resección de colon, tanto del lado derecho como el izquierdo se consideraron elegibles. Los criterios de exclusión fueron tener menos de 18 años, deterioro cognitivo o incapacidad para entender sueco/danés. Los pacientes completaron extensos cuestionarios en el momento del diagnóstico y después de uno y tres años. Los datos clínicos se complementaron con los registros de calidad binacionales.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluaron los síntomas intestinales específicos, la puntuación LARS y la angustia manifestada por cada paciente.RESULTADOS:De 1221 pacientes (tasa de respuesta del 83%), el 17% informó LARS mayor un año después de cualquier tipo de resección, consistente a los tres años (17% derecha, 16% izquierda). A largo plazo, la única diferencia significativa entre los tipos de resección fue una alta incidencia de heces liquidas después de las resecciones del lado derecho. En general, menos de una quinta parte de los pacientes experimentaron angustia, y fué la poblacion femenina quién informó de síntomas más frecuentes y de mayor angustia. En particular, la incontinencia y las heces liquidas se correlacionaron fuertemente con la angustia.LIMITACIONES:Ausencia de datos de función intestinal previos al diagnóstico.CONCLUSIONES:Nuestro estudio indica que la función intestinal permanece en gran medida intacta después de la resección del colon, y sólo una minoría reporta malestar significativo. Los resultados adversos fueron más comunes en la población femenina. La aparición de heces liquidas después de la resección del lado derecho y la asociación entre incontinencia, heces liquidas y malestar resalta la necesidad de evaluaciones postoperatorias y valoraciones más exhaustivas más allá de la puntuación LARS al evaluar a los pacientes con cáncer de colon. (Traducción-Dr. Xavier Delgadillo ).

How well do we measure the impact of bowel dysfunction on health-related quality of life after rectal cancer surgery?

BackgroundRectal cancer surgery risks causing bowel dysfunction, which has an important impact on health-related quality of life. The validity of generic tools used to measure health-related quality of life after bowel dysfunction is unclear. This study aimed to determine the content validity of health-related quality-of-life measurement tools in rectal cancer. MethodsThis was a qualitative single-center study in which adult patients who underwent rectal cancer surgery with sphincter preservation from July 2017 to October 2020 were recruited. Patients were excluded if they developed local metastasis, required a permanent stoma, or had surgery <1 year since recruitment. Telephone-based semi-structured interviews were conducted. Bowel dysfunction was measured using the Low Anterior Resection Syndrome score. Content analysis was achieved using the International Classification of Functioning framework. ResultsRecurrent bowel dysfunction-related concepts included “Mental functions,” “Defecation functions,” “Emotional functions,” “Recreation and leisure,” “Intimate relationships,” and “Remunerative employment.” A mean of 7.5 recurrent bowel dysfunction-related concepts were identified within the health-related quality of life instruments analyzed. The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (n = 11) and the 36-Item Short Form Health Survey (n = 9) covered the greatest number of recurrent bowel dysfunction-related concepts. Concepts such as “Mental functions,” “Urination functions,” “Sexual functions,” “Driving,” and “Mobility” were not covered by any instrument. ConclusionThe content of traditional health-related quality-of-life instruments is missing important areas that represent the impact of bowel dysfunction after rectal cancer surgery on health-related quality of life. These findings could help improve patient-centered care in rectal cancer surgery.

Low anterior resection syndrome phenotypes-Different symptom profiles for different patients.

Attention is increasingly being turned to functional outcomes as being central to colorectal cancer (CRC) survivorship. The current literature may underestimate the impact of evacuatory dysfunction on patient satisfaction with bowel function after anterior resection (AR) for CRC. The aim of this study was to investigate the impact of post-AR symptoms of storage and evacuatory dysfunction on patient satisfaction and health-related quality of life (HRQoL). A cross-sectional study was performed at an Australian hospital of patients post-AR for CRC (2012-2021). The postoperative bowel function scores used were: low anterior resection syndrome (LARS), St Mark's incontinence, Cleveland Clinic constipation and Altomare obstructive defaecation syndrome scores. Eight 'storage' and 'evacuatory' dysfunction symptoms were derived. A seven-point Likert scale measured patient satisfaction. The SF36v2® measured HRQoL. Linear regression assessed the association between symptoms, patient satisfaction and HRQoL. Overall, 248 patients participated (mean age 70.8 years, 57.3% male), comprising 103 with rectal cancer and 145 with sigmoid cancer. Of the symptoms that had a negative impact on patient satisfaction, six reflected evacuatory dysfunction, namely excessive straining (p < 0.001), one or more unsuccessful bowel movement attempt(s)/24 h (p < 0.001), anal/vaginal digitation (p = 0.005), regular enema use (p = 0.004), toilet revisiting (p = 0.004) and >10 min toileting (p = 0.004), and four reflected storage dysfunction, namely leaking flatus (p = 0.002), faecal urgency (p = 0.005), use of antidiarrhoeal medication (p = 0.001) and incontinence-related lifestyle alterations (p < 0.001). A total of 130 patients (53.5%) had 'no LARS', 56 (23.1%) had 'minor LARS' and 57 (23.4%) had 'major LARS'. Fifty-seven (44.5%) patients classified as having 'no LARS' had evacuatory dysfunction. Postoperative storage and evacuatory dysfunction symptoms have an adverse impact on patient satisfaction and HRQoL post-AR. The importance of comprehensively documenting symptoms of evacuatory dysfunction is highlighted. Further research is required to develop a patient satisfaction-weighted LARS-specific HRQoL instrument.

Comparison of a robotic surgery program for rectal cancer: short- and long-term results from a comparative, retrospective study between two laparoscopic and robotic reference centers.

It is assumed that robotic-assisted surgery (RAS) may facilitate complex pelvic dissection for rectal cancer compared to the laparoscopic-assisted resection(LAR). The aim of this study was to compare perioperative morbidity, short- and long-term oncologic, and functional outcomes between the RAS and LAR approaches. Between 2015 and 2021, all rectal cancers operated on by (LAR) or (RAS) were retrospectively reviewed in two colorectal surgery centers. A total of 197 patients were included in the study, with 70% in the LAR group and 30% in the RAS group. The tumor location and stage were identical in both groups (not significant = NS). The overall postoperative mortality rate was not significantly different between the two groups. (0% LAR; 0.5% RAS; NS). The postoperative morbidity was similar between the two groups (60% LAR vs 57% RAS; NS). The number of early surgical re-interventions within the first 30days was similar (10% for the LAR group and 3% for the RAS group; NS). The rate of complete TME was similar (88% for the LAR group and 94% for the RAS group; NS). However, the rate of circumferential R1 was significantly higher in the LAR group (13%) compared to the RAS group (2%) (p = 0.009). The 3-year recurrence rate did not differ between the two groups (77% for both groups; NS). After a mean follow-up of three years, the incidence of anterior resection syndrome was significantly lower in the LAR group compared to the RAS group (54 vs 76%; p = 0.030). The use of a RAS was found to be reliable for oncologic outcomes and morbidity. However, the expected benefits for functional outcomes were not observed. Therefore, the added value of RAS for rectal cancer needs to be reassessed in light of new laparoscopic technologies and patient management options.

Baseline characteristics and recruitment for SWOG S1820: altering intake, managing bowel symptoms in survivors of rectal cancer (AIMS-RC)

PurposeMany survivors of rectal cancer experience persistent bowel dysfunction. There are few evidence-based symptom management interventions to improve bowel control. The purpose of this study is to describe recruitment and pre-randomization baseline sociodemographic, health status, and clinical characteristics for SWOG S1820, a trial of the Altering Intake, Managing Symptoms in Rectal Cancer (AIMS-RC) intervention.MethodsSWOG S1820 aimed to determine the preliminary efficacy, feasibility, and acceptability of AIMS-RC, a symptom management intervention for bowel health, comparing intervention to attention control. Survivors with a history of cancers of the rectosigmoid colon or rectum, within 6–24 months of primary treatment completion, with a post-surgical permanent ostomy or anastomosis, and over 18 years of age were enrolled. Outcomes included total bowel function, low anterior resection syndrome, quality of life, motivation for managing bowel health, self-efficacy for managing symptoms, positive and negative affect, and study feasibility and acceptability.ResultsThe trial completed accrual over a 29-month period and enrolled 117 participants from 34 institutions across 17 states and one US Pacific territory. At baseline, most enrolled participants reported self-imposed diet adjustments after surgery, persistent dietary intolerances, and bowel discomfort post-treatment, with high levels of constipation and diarrhea (grades 1–4).ConclusionsSWOG S1820 was able to recruit, in a timely manner, a study cohort that is demographically representative of US survivors of rectal cancer. Baseline characteristics illustrate the connection between diet/eating and bowel symptoms post-treatment, with many participants reporting diet adjustments and persistent inability to be comfortable with dietary intake.ClinicalTrials.gov registration date12/19/2019.ClinicalTrials.gov IdentifierNCT#04205955.

Evaluation of the Low Anterior Resection Syndrome and Quality of Life in Patients Having Undergone Sphincter Sparing Rectal Cancer Surgery

Abstract Background In order to avoid abdomino-perineal amputation and permanent colostomy in patients with low rectal cancer sphincter sparing low anterior resection (SSLAR) techniques with/without neoadjuvant radio-chemotherapy are administered. However, a lot of SSLAR-patients have life quality limiting symptoms afterwards, like fecal urgency, incontinence, constipation and sensation of incomplete rectal emptying. Such symptoms are defined as “low anterior resection syndrome” (LARS). LARS quantification can be made by a specific and validated quality of life (QoL) questionnaire (see annex). Aims Assessment of the QoL in patients after SSLAR suffering from LARS before and after specific therapy. Methods This is a monocentric, retrospective cohort study including patients having undergone SSLAR for rectal cancer 2014 - 2021. Initial LARS-scores were obtained by completion of the specific questionnaire. Patients with a minor LARS (scores 21-29) were treated with electrostimulation and bio-feedback physiotherapy. Those with a major LARS (scores &amp;gt;29) were first investigated by anal manometry followed by physiotherapy. After treatment LARS-scores were obtained again. Results Of 136 identified SSLAR-patients, 68 did not fulfill the inclusion criteria’s (see annex). Of the remaining 54 patients, 20.4% had a minor, 37% a major and 42.6% no LARS. Of all LARS-patients, 13 completed pelvic physiotherapy, 4 are still completing and 14 (26%) refused such a treatment. The mean-LARS score was 32.77 and 22.92, before and after treatment, respectively (p=0.004). Risk factor analysis (diabetes, type of anastomosis, neoadjuvant radio-chemotherapy, previous operations, nicotine, alcohol) did not reveal any significant difference between groups. Conclusion More than 50% of patients undergoing SSLAR are suffering from LARS, more than one third from major LARS. QoL is impressively improved by specific physiotherapeutic measures. In order to avoid later treatment hesitancy (26%), we began to initiate early specific physiotherapy as a standard in all SSLAR-patients.

Is transanal irrigation the best treatment possibility for low anterior resection syndrome? A multicenter, randomized clinical trial: study protocol.

Up to 50% of patients who undergo rectal resection suffer from various and partly severe functional problems, despite the preservation of the anal sphincter. These complaints are defined as low anterior resection syndrome (LARS). So far, there are no randomized clinical trials regarding the most effective treatment for LARS. Our aim is to evaluate whether transanal irrigation improves bowel function and quality of life in patients following low anterior resection compared to best supportive care. Patients who have undergone low anterior resection will be approached for this study. On patient's visit, complaints regarding the defecation as well as any deterioration in their overall quality of life will be assessed using questionnaires such as the Low Anterior Resection Syndromes score, Wexner score, European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QOL) CR-29, and Measure Yourself Medical Outcome Profile tool. Few additional target questions will be also asked, such as "Would you recommend the treatment to anybody; did you expect the improvement following the treatment; etc." Questionnaires and scales will be filled on follow-up visits every 3 months for 1 year. This multicenter, randomized controlled trial will lead to a better understanding of LARS treatment. Moreover, it will be a hypothesis-generating study and will inform areas needing future prospective studies. ClinicalTrials.gov, identifier (NCT05920681).

Low Anterior Resection Syndrome and Quality of Life of Patients After Sphincter Preservation Surgery: A Prospective Study.

Background After anterior resection (AR), one of the most debilitating complications is low anterior resection syndrome (LARS) seenin about 64% of patients. The severity of the LARS score wassignificantly correlated with neoadjuvant treatment, the extent of rectal surgery, complication by the anastomotic leak, female gender, and age < 64 years. In this study, weanalyzed the impact of various clinical factors on LARS and also the various domains of quality of life (QoL). Purpose To assess the incidence of LARS in patients undergoing sphincter-sparing surgery for rectal cancer after the patient starts long-term defecating per anus, change in the QoL, and relation to LARS and factors affecting it. Methods One year before, 72 patients who had undergone AR in the Regional Cancer Centre were interviewed by a trained interviewer and data was collected from the file. Thequestionnairesused were the Wexner Incontinence score, LARS Malayalam Questionnaire, and European Organisation For Research and Treatment of Cancer (EORTC) QLQ C30 Malayalam translations. Statistical measures The LARS score wasused to categorize patients into three grades. The scores werecompared with clinical and social factors using the χ2 test for association. Continuous variables were compared by the Spearman Rho test. Results Details of patients were studied(male: 55.6% (40) andfemale: 44.4% (32)). Fifty patientsunderwent low anterior resection (LAR). The mean LARSscore was 25.61, with 47.2% of patients having severe LARS score. The mean Wexner score was 6.84. The relation withtype of surgery, approach (laparoscopic vs open), or type of neoadjuvant therapy was not found to be significant. A higher LARS score did not impact overall QoL as assessed by FACT-C. Insomnia and diarrhea symptoms scores were significantly worsened. The pain score was worse for those undergoing stapler anastomosis. Wexner's score was worse for those who had received adjuvant chemotherapy. Role functioning score was better for AR compared to low anterior resection (LAR). Only distance from the anal verge was found to be a significant cause of LARS and was negatively correlated. Discussion LARS of severe degrees were seen in most patients. No modifiable risk factors were significantly found to affect the chance of LARS. However, LARS did not have a significant impact on QoL, neither did the type of surgery. So sphincter preservation can be offered to the patients, but all patients undergoing LAR should be counseled well about the risk ofLARS before surgery.

LASSO-based nomogram predicts the risk factors of low anterior resection syndrome for middle and low rectal cancer underwent robotic surgery.

This study aims to analyze the influencing factors of postoperative Low Anterior Resection Syndrome (LARS) in patients with middle and low rectal cancer who underwent robotic surgery. It also seeks to predict the probability of LARS through a visual, quantitative, and graphical nomogram. This approach is expected to lower the risk of postoperative LARS in these patients and improve their quality of life through effective prevention and early intervention. This research involved patients with middle and low rectal cancer who underwent robotic surgery in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Nanchang University from January 2015 to October 2022. A series of intestinal dysfunction symptoms arising from postoperative rectal cancer were diagnosed and graded using LARS scoring criteria. After the initial screening of all variables related to LARS with Lasso regression, they were included in logistic regression for further univariate and multivariate analysis to identify independent risk factors for LARS. A prediction model was then constructed. The study included 358 patients. The parameters identified by Lasso regression included obstruction, BMI, tumor localization, maximum tumor diameter, AJCC stage, stoma, neoadjuvant therapy (NAT), and postoperative adjuvant therapy (AT). Univariate and multivariate analyses indicated that a higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and postoperative adjuvant therapy were independent risk factors for total LARS. The AUC of the prediction nomogram was 0.834, with a sensitivity of 0.825 and specificity of 0.741. The calibration curve demonstrated excellent concordance with the nomogram, indicating the prediction curve fit the diagonal well. Higher BMI, lower tumor localization, higher AJCC stage, neoadjuvant therapy, and adjuvant therapy were identified as independent risk factors for total LARS. A new predictive nomogram for postoperative LARS in patients with middle and low rectal cancer undergoing robotic surgery was developed, proving to be stable and reliable. This tool will assist clinicians in managing the postoperative treatment of these patients, facilitating better clinical decision-making and maximizing patient benefits.

Low Anterior Resection Syndrome after Surgeries for Distal Rectal Cancer: Literature Review

Low Anterior Resection Syndrome after Surgeries for Distal Rectal Cancer: Literature Review

The Effect of Pelvic Floor Rehabilitation on Low Anterior Resection Syndrome After Colorectal Cancer Treatment

Purpose: Low anterior resection (LAR) is the preferred surgical treatment of rectosigmoid or rectal cancers. However, it is often associated with bowel dysfunction, which is termed low anterior resection syndrome (LARS). Daily bowel dysfunction symptoms have a detrimental effect on quality of life (QOL). Pelvic floor rehabilitation (PFR) can improve pelvic floor function and QOL among patients with LARS. This quality improvement (QI) project seeks to assess the prevalence of LARS and develop and incorporate PFR for the treatment and prevention of LARS. Methods: A convenience sample of 20 patients met project inclusion. Thirteen patients participated. Individuals were categorized by diagnostic risk: low risk, high risk, and established. The intervention included 1-hour PFR sessions with the physical therapist (PT) and 5 minutes of daily self-led pelvic floor muscle exercises. Outcomes questionnaires included the LARS Score and Fecal Incontinence Quality of Life (FIQOL) Scale. Data were collected both pre- and post–colorectal cancer treatment. Results: The overall prevalence of LARS was 76.9%, which was significantly higher than the retrospective cohort comparison rate of 21.8% (p &lt; .001). The prevalence of major LARS was 89%, 83%, and 50% at the initial, second, and third sessions, respectively, representing a 44% relative decrease. Embarrassment was significantly affected among individuals with major LARS, although ongoing PFR facilitated improvement. Conclusion: PFR is a valuable adjunct therapy for LARS, with continued sessions decreasing the overall prevalence among the cohort. Major LARS negatively impacts QOL measures early on in treatment but improves with continued PFR.

Functional outcomes following anterior resection for colorectal cancer: a needs assessment and proposal of a nurse-led remote management algorithm.

With the rise of structured, remote follow-up of colorectal cancers, there is the potential risk of underdiagnosing and undermanaging low anterior resection syndrome (LARS). This cohort study aims to determine the rate of LARS and its patterns of care, with the aim of generating a risk-stratified management algorithm that can be employed for nurse-led follow-up. Patients who underwent elective anterior resection for the management of colorectal cancer between 1 January 2017 and 31 December 2021 were sent quality-of-life questionnaires (EORTC-QLQ-CR29 and LARS score) and surveyed for LARS symptoms and management utilized. Out of 70 patients who completed questionnaires, 71.4% had LARS and 42.9% had major LARS. The international Delphi consensus definition identified more patients (n = 50) with LARS than the LARS score (n = 41). Tumours located <8 cm from the anal verge, ULAR, and temporary stoma were predictive of major LARS on univariate analysis. However, only temporary stoma was predictive for LARS (OR 7.89 (1.15-53.95), P = 0.035) and majors LARS (8.14 (1.79-37.01), P = 0.007) on multivariate analysis. Forty-four percent of patients with LARS did not have input from any health professional for this condition. Consultation with specialist allied health and/or colorectal surgeons ranged from 4% to 22%. Our study highlights that with the current remote follow-up system focused on cancer outcomes a significant proportion of patients with LARS are overlooked, resulting in the underutilization of relevant health professionals and management options. We propose a nurse-led management algorithm to address this issue while still minimizing surgical outpatient load.

Robotic intersphincteric resection of low rectal cancer versus laparoscopic intersphincteric resection of low rectal cancer

This systematic review evaluated and compared the two currently available intersphincteric resection techniques (robotic and laparoscopic intersphincteric resection) for low rectal cancer, with the final aim of comparing associated factors between the two techniques. The assessed factors included surgical duration, hospital stay, complications, overall survival, local recurrence, and low anterior resection syndrome (LARS). A literature search of the search engines “PubMed”, “SCOPUS”, and “Web of Science” was conducted, with a time interval set between 2015 and 2023. The initial search yielded 57 studies, of which 10 met the inclusion and exclusion criteria. Hence, data was extracted from only these 10 studies. The average reported robotic surgery time varied between 197 and 472 mins, while the laparoscopic surgery time varied between 240 and 325 mins. Conversely, the overall survival and local recurrence rates were 89.7% and 6.7% for robotic and 87.9% and 6.2% for laparoscopic resection, respectively. In addition, complications were reported in 16.5% and 18.2% of robotic and laparoscopic resection cases, respectively. This systematic review showed that although the surgery duration is longer in robotic resection compared to laparoscopic resection, the former technique is associated with lower rates of complications and local recurrence, and improved overall survival. In addition, few studies have reported on the prevalence of LARS; therefore, we recommend that this field be studied and included in the reported data of the upcoming studies to allow more conclusive evidence regarding prevalence of LARS among the two groups of intersphincteric resections.

Correlation between Pain and Anal Defecation Function in Postoperative Patients with Colorectal Cancer and Related Factors Affecting Patients' Prognosis.

The degree of postoperative pain and defecation function in colorectal cancer will affect patients' prognosis. Therefore, exploring the correlation between postoperative pain and defecation function, and analyzing the related factors, will help to improve the quality of patients' prognosis. A total of 94 patients with colorectal cancer admitted to our hospital from March 2022 to June 2023 were retrospectively selected for study. The visual analog scale (VAS) was used to evaluate the pain level of the patients. The low anterior resection syndrome (LARS) scale was used to evaluate bowel function of the patients, and the incidence of LARS was recorded. The patients were grouped according to whether or not they had the complications of LARS, and they were divided into the groups of concurrent LARS and non-concurrent LARS. The patients' anorectal pressure was measured, and the measurements included maximum tolerated volume (MTV), anorectal resting pressure (ARP), and maximum squeeze pressure (MSP). Pearson's correlation coefficient was used to test associations between anal defecation function and postoperative pain and anorectal manometry. Logistic regression was used to test predictors of concurrent LARS, and the value of each of the indices for prediction of LARS was examined using the receiver operating characteristic (ROC). Patients' VAS scores were positively correlated with LARS scores (p < 0.05). A total of 22 patients with VAS score ≥20 points were found to have a LARS incidence of 23.40% based on the LARS score. The VAS score was higher in the concurrent LARS group than in the non-concurrent LARS group (p < 0.05). The concurrent LARS group had a higher percentage of patients with age ≥60 years, body mass index ≥24 kg/m2, anastomotic position <5 cm from the anal verge, preoperative radiotherapy, and anastomotic fistula than the non-current LARS group (p < 0.05). The levels of MTV, ARP, and MSP were lower in patients in the concurrent LARS group than in the non-current LARS group (p < 0.05). Patients' LARS scores were negatively correlated with MTV (r = -0.420), ARP (r = -0.300) and MSP (r = -0.220) levels (p < 0.05). Logistic regression analysis showed that anastomotic position <5 cm from the anal verge, preoperative radiotherapy, anastomotic fistula, high VAS level, and low MTV level were all significant predictors of concurrent LARS. Anastomotic position, whether or not radiotherapy was administered preoperatively, anastomotic fistula, VAS score, and MSP level all had high sensitivity and specificity for prediction of concurrent LARS, and the combined area under the curve (AUC) of each index was 0.921, sensitivity was 0.818, and specificity was 0.944. LARS is strongly associated with the patient's pain level, and factors such as anastomotic position <5 cm from the anal verge, preoperative radiotherapy, anastomotic fistula, high VAS level, and low MTV level will increase the risk of concurrent LARS in patients.

Effect of Robotic Inferior Mesenteric Artery Ligation Level on Low Anterior Resection Syndrome in Rectum Cancer.

Background: Life expectancy of patients with rectal cancer is increasing day by day with innovative treatments. Low anterior resection syndrome (LARS), which disrupts the comfort of life in these patients, has become a serious problem. We aimed to evaluate the effect of high ligation (HL) and low ligation (LL) techniques on LARS in rectal cancer surgery performed with the robotic method. Materials and Methods: The data of patients diagnosed with mid-distal rectal cancer between 2016 and 2021 who underwent robotic low anterior resection by the same team in the same center with neoadjuvant chemoradiotherapy were retrospectively evaluated. Patients were divided into two groups as those who underwent HL and LL procedures. Preoperative, 8 weeks after neoadjuvant treatment, 3 and 12 months after ileostomy closure were evaluated. Results: A total of 84 patients (41 HL, 43 LL) were included in the study. There was no statistically significant difference between the demographic characteristics and pathology data of the patients. Although there was a decrease in LARS scores after neoadjuvant treatment, there was a statistically significant difference between the two groups at 3 and 12 months after ileostomy closure (P: .001, P: .015). Conclusions: In patients who underwent robotic low anterior resection, there is a statistically significant difference in the LARS score in the first 1 year with the LL technique compared with that of the HL technique, and the LL technique has superiority in reducing the development of LARS between the two oncologically indistinguishable methods.

Functional outcomes of bowel resection versus shaving or disc excision of colorectal endometriosis: a systematic review protocol

IntroductionEndometriosis is a prevalent gynaecological condition for women of reproductive age worldwide. While endometriosis primarily involves the reproductive system, it can also infiltrate additional viscera such as the gastrointestinal tract....

Clinical Outcomes of Ileostomy Closure during versus after Adjuvant Chemotherapy in Patients with Rectal Cancer.

Protective ileostomy can effectively prevent severe anastomotic leakage after rectal cancer surgery; however, the optimal timing for ileostomy closure during adjuvant chemotherapy remains unclear. This study aimed to explore the safety and long-term outcomes of early ileostomy closure during adjuvant chemotherapy. Patients who underwent laparoscopic rectal cancer surgery combined with protective ileostomy and adjuvant chemotherapy between April 2017 and April 2021 were retrospectively evaluated. Patients were divided into an early closure group during chemotherapy (group A) and a late closure group after chemotherapy (group B). A total of 215 patients were included in this study, with 115 in group A and 100 in group B. There were no significant differences in demographic and clinical characteristics between the two groups. In group A, durations of stoma status (p < 0.001) and low anterior resection syndrome (LARS) (p < 0.001) were shorter, and rectal stenosis (p=0.036) and stoma-related complications (p=0.007), especially stoma stenosis (p=0.041), were less common. However, compliance with chemotherapy was worse (p=0.009). There were no significant differences in operative time, postoperative hospital stay, postoperative complications, incidence and severity of LARS, disease-free survival, or overall survival between groups. Early ileostomy closure can effectively reduce the duration of stoma status, duration of LARS, rectal stenosis, and stoma-related complications while not affecting surgical complications and oncological outcomes. Ileostomy closure should not be delayed because of adjuvant chemotherapy. However, follow-up should be strengthened to increase compliance and integrity with chemotherapy.