Low Anterior Resection Syndrome Score Research Articles

Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study.

Restorative anterior resection is considered the optimal procedure for most patients with rectal cancer and is frequently preceded by radiotherapy. Both surgery and preoperative radiotherapy impair bowel function, which adversely affects quality of life. This study aimed to report symptoms associated with and key predictors for bowel-related quality-of-life impairment. The study included a cross-sectional cohort. This was a multicenter study from 12 United Kingdom centers. A total of 578 patients with rectal cancer underwent curative restorative anterior resection between 2001 and 2012 (median, 5.25 years postsurgery). Patients completed outcome measures that assessed bowel dysfunction (low anterior resection syndrome score), incontinence (Wexner score), and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30), plus an anchor question: "Overall how does bowel function affect your quality of life?" The response rate was 80% (462/578). Overall, 85% (391/462) of patients reported bowel-related quality-of-life impairment, with 40% (187/462) reporting major impairment. A large difference in global quality of life (22 points; p < 0.001) was reported for "none" versus "major" impairment, with greatest symptom severity being diarrhea (25 points; p < 0.001), insomnia (24 points; p < 0.001), and fatigue (20 points; p < 0.001). Regression analysis identified major impairment in 60% and 45% of patients with low rectal cancer treated with and without preoperative radiotherapy compared with 47% and 33% of middle/upper rectal cancers with and without preoperative radiotherapy. Advances in radiotherapy delivery and improvements in posttreatment symptom control, although currently of limited efficacy, imply that the content of this consent aid should be re-evaluated in 5 to 10 years. Before a restorative anterior resection, patients with rectal cancer should be informed that bowel-related quality-of-life impairment is common. The key risk factors are neoadjuvant therapy and a low tumor height. This study presents quality-of-life and functional outcome data, along with a consent aid, that will enhance this preoperative patient discussion.

Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis

BackgroundIn recent decades there has been an increasing trend toward sphincter-preserving procedures for the treatment of low rectal cancer. Robotic surgery is considered to be particularly beneficial when operating in the deep pelvis, where laparoscopy presents technical limitations. The aim of this study was to prospectively evaluate the functional outcomes in patients affected by rectal cancer after robotic total intersphincteric resection (ISR) with hand-sewn coloanal anastomosis. Methods and proceduresFrom March 2008 to October 2012, 23 consecutive patients affected by distal rectal adenocarcinoma underwent robotic ISR. Operative, clinical, pathological and functional data regarding continence or presence of a low anterior resection syndrome (LARS) were prospectively collected in a database. ResultsTwenty-three consecutive patients were included in the study: 8 men and 15 women. The mean age was 60.2 years (range 28–73). Eighteen (78.3%) had neoadjuvant radiochemotherapy. Conversion rate was nil. The mean operative time was 296.01 min and the mean postoperative hospital stay was 7.43 ± 1.73 days. According to Kirwan's incontinence score, good fecal continence was shown in 85.7% of patients (Grade 1 and 2) and none required a colostomy (Grade 4). Concerning LARS score, the results were as follows: 57.1% patients had no LARS; 19% minor LARS and 23.8% major LARS. ConclusionsRobotic total ISR for low rectal cancer is an acceptable alternative to traditional procedures. Extensive discussion with the patient about the risk of poor functional outcomes or LARS syndrome is mandatory when considering an ISR for treatment of low rectal cancer.

Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study.

To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis. Prospectively collected data regarding the function of the pelvic organs. Tertiary endometriosis referral unit, Aarhus University Hospital. A cohort of 128 patients who underwent laparoscopic bowel resection for endometriosis. The International Consultation on Incontinence Questionnaire (ICIQ), Sexual Function-Vaginal Changes Questionnaire (SVQ), and the Low Anterior Resection Syndrome (LARS) questionnaire were answered before and after surgery. Non-invasive urodynamic testing was performed. Pre- and postoperative function of the pelvic organs was compared, and risk factors for improved/impaired function were identified. A total of 96.1% of the women completed the 1-year follow-up. A significant decrease (P=0.002) in bladder filling problems (F-score) was observed 1year after surgery, primarily caused by a significant decrease in bladder pain (P=0.0001). No change for urodynamic parameters was observed. A significant increase in overall sexual satisfaction (P=0.0001) and decrease in worries about sexual life (P=0.001) was seen 1year after surgery. Frequency of defecation was significantly increased 1year after surgery (P=0.0001), but the overall bowel function measured by LARS score was unchanged. Patients with anastomotic leakage had a significantly higher risk (odds ratio, OR5.40; P=0.002) of increased incontinence problems (I-score) 1year after surgery. A significant and clinically relevant improvement in urinary and sexual function 1year after laparoscopic bowel resection for endometriosis was found. Except for anastomotic leakage, this could be observed independent of any patient- or treatment-related factor. Apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection in endometriosis patients. Rectal resection for endometriosis does not impair urinary and sexual function 1year after surgery.

Validity and reliability of a Lithuanian version of low anterior resection syndrome score.

Up to 90% of patients undergoing low anterior resection complain of increased daily bowel movements, urgency, and a variable degree of incontinence. A symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer has recently been developed and validated. The aim of our study was to adapt the low anterior resection syndrome (LARS) scale questionnaire to the Lithuanian language, and assess its psychometric properties. The LARS questionnaire was translated into Lithuanian by the Scientific Advisory Committee of the Medical Outcomes Trust using a standard procedure of double-back translation. The Lithuanian version of the LARS (LARS-LT) questionnaire was completed by 111 patients who underwent low anterior resection with total mesorectal excision in the period from January 1, 2008, to December 31, 2012, at the National Cancer Institute. An anchor question from the Wexner score assessing the impact of bowel function on lifestyle was included. A subgroup of 20 patients completed the LARS-LT questionnaire twice. Validity was tested using a factor analysis, and internal reliability was estimated using the Cronbach's alpha and intraclass correlation coefficients. Twenty-seven patients (25%) had no LARS, 26 (24%) had minor LARS, and 55 (56%) had major LARS. The response rate was 60.7%. The LARS-LT showed significantly high reliability and internal consistency [Cronbach's α=0.88, interclass correlation coefficient-0.86 (0.71-0.98)]. The LARS score showed significant correlations with the lifestyle question (p<0.05). It could not detect differences between female and male patient groups (p=0.33), patients' age (p=0.45), patients who had/had not undergone radiation therapy (p=0.07), and those in whom the distal edge of the tumor was close to or far from the anal verge (p=0.17). The Lithuanian version of the LARS-LT shows acceptable psychometric properties and can be considered a valuable and specific instrument to assess bowel function in rectal cancer patients, both for research purposes and in clinical practice.

Long-Term Functional Outcomes of Total Mesorectal Excision Following Chemoradiotherapy for Lower Rectal Cancer: Stapled Anastomosis versus Intersphincteric Resection

Aims: To compare the long-term functional outcomes of total mesorectal excision following chemoradiotherapy for lower rectal cancer between stapled anastomosis and intersphincteric resection (ISR). Methods: A total of 105 of 170 sphincter-preserving patients found to be disease-free and anal functional patients were assessed at 6.5 years (range 2.4-13.0 years) of follow-up after surgery. Of these subjects, 87 (double stapling technique [DST]: 41; ISR: 46) of the 105 patients (82.9%) responded to the questionnaire on the low anterior resection syndrome score (LARS score). Results: The total LARS scores in the DST and ISR groups were not significantly different (Major/Minor/No LARS = 23/14/4 and 31/10/5, p = 0.431). When considering each item of the LARS, ISR was associated with poorer incontinence scores than DST. Conversely, the scores for the frequency of bowel movement, clustering and urgency were not different between the 2 groups. In addition, in the multivariate analysis, the tumor distance from the anal verge and postoperative period was independently associated with Major LARS. Conclusion: In this study, we demonstrate the long-term functional outcomes of irradiated lower rectal cancer reconstructed with DST and ISR. Bowel function improves over time; therefore, long-term patient follow-up is important.

Midterm functional results of taTME with neuromapping for low rectal cancer.

Information on functional outcomes after laparoscopic-assisted transanal total mesorectal excision (taTME) is limited. This study analyzed the functional results in patients with low rectal cancer. Ten consecutive patients (nine males) undergoing electrophysiologically controlled nerve-sparing taTME were investigated prospectively and asked to complete functional questionnaires [the International Prostate Symptom Score (IPSS), International Index of Erectile Function, Female Sexual Function Index, Wexner score, and low anterior resection syndrome (LARS) score]. Bladder function was also assessed according to residual urine volume. Preoperative function was compared to the functional outcome 3 and 6 months, and 9 months if eligible, after stoma closure or surgery in the absence of a diverting stoma. Prior to therapy, urinary and sexual function was impaired in 40 and 60% of patients, respectively. None of the patients developed pathological residual urine volumes after at least unilateral functional pelvic nerve-sparing. Median IPSS was lower than preoperative scores (p > 0.05). Two males with incomplete nerve preservation were considered impotent during a median follow-up of 15 months (range 6-20 months). The female was judged to be sexually inactive. The median Wexner score was 1 (range 0-7) prior to any therapy and increased to 7 (range 0-15) at 6 months (p = 0.029), with 40% of patients categorized as having no LARS and 50% minor LARS. The median LARS score was 28 (range 9-38) at 3 months and 26 (range 9-32) at 6 months (p = 0.165). Despite a small sample size and confounding factors, data indicate that taTME has the potential to preserve continence, sufficient bowel function, and urogenital function.

Validation of the English translation of the low anterior resection syndrome score.

Many patients having anterior resection for rectal cancer suffer from severe long-term bowel dysfunction, known as low anterior resection syndrome (LARS). The LARS score was developed in Denmark, and Swedish, Spanish and German versions have been validated. The aim of this study was to validate the English translation of the LARS score in British rectal cancer patients. Rectal cancer patients who underwent an anterior resection in 12 UK centres received the LARS score questionnaire, the EORTC QLQ-C30 and a single ad hoc quality of life question. A subgroup of patients received the LARS score questionnaire twice. The response rate was 80% and 451 patients were included in the analyses. A strong association between LARS score and quality of life (convergent validity) was found (P < 0.01), discriminative validity was good (P < 0.02) and the test-retest reliability was high (intraclass correlation coefficient 0.83). The English translation of the LARS score has shown good psychometric properties comparable with recently published results from an international multicentre study. Thus, the English translation of the LARS score can be considered a valid and reliable tool for measuring LARS.

Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients

Defective defecation function, also known as low anterior resection syndrome (LARS), is a common problem after surgical treatment of rectal cancer that has a detrimental effect on quality of life. This study aimed to look for the incidence of LARS in patients whose native rectum could not be kept and determine factors influencing major LARS. Rectal cancer patients who underwent tumor removal with mesorectal excision and colorectal anastomosis by a colorectal surgeon during the years 2004-2013 were asked to participate a structured interview using the verified version of the Low Anterior Resection Score questionnaire. Clinical parameters were analyzed against the incidence of major LARS. The cut-off anastomotic level that corresponded to the risk of major LARS was calculated by using a receiver operating characteristic curve. Anorectal physiology was compared between those with major LARS and those without LARS by anorectal manometry. This study included 129 patients (67 men and 62 women). Incidences of minor LARS (LAR score 21-29) and major LARS (LARS score≥30) score 21een those with major LARS and those univariate analysis, factors associated with major LARS were extent of operation, presence of temporary ostomy, and chemoradiation therapy. Major LARS was found at 28.2% in those who underwent low anterior resection, which was significantly higher than the incidence of 5.2% in the anterior resection group (p<0.01). Radiation therapy was the only factor independently associated with major LARS at an odds ratio of 6.55 (95% confidence interval: 2.37-18.15). The receiver operating characteristic curve plot between sensitivity and specificity of the anastomotic level in determining major LARS showed an area under the curve of 0.73. The cut-off anastomotic level that best predicted major LARS was at 5cm, which gave a negative predictive value of 89%. Individual defecation symptoms that were significantly associated with major LARS included pain on defecation, difficulty holding stool, and needing to use a pad. Anorectal manometry showed a significant difference in the resting anal pressure and squeeze pressure, which suggests that derangement in sphincteric function caused by surgery and postoperative adjuvant treatment may contribute to the LARS. LARS is a significant problem found in about one third of rectal cancer patients after colorectal anastomosis. Symptoms of concern include pain on defecation and decreased ability to hold. Risk of having major LARS increases with adjuvant treatment and lower anastomotic level.

Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery

BackgroundThe combination of advances in surgical technique and neoadjuvant therapy for rectal cancer has resulted in more patients undergoing sphincter-preserving surgery. Unfortunately, numerous patients subsequently experience bowel dysfunction, and may suffer from lifelong severe disability with major impact on their quality of life. The aim of the present study was to investigate whether the risk of severe LARS in patients was associated with the length of remnant rectum. MethodsA total of 125 patients who underwent sphincter-preserving surgery for rectal cancer were included. Postoperative bowel function was assessed using the low anterior resection syndrome (LARS) score a minimum of one year following surgery. The length of remnant rectum was measured on postoperative MRI of the pelvis and was correlated with the risk of having major LARS. ResultsOverall, major LARS was observed in 38 per cent of patients. In the patients who underwent surgery alone, major LARS was reported by 27 per cent, and a larger remnant rectum was associated with a better functional outcome. In contrast, 80 per cent of patients who underwent combined preoperative chemoradiotherapy and surgery reported having major LARS. No association between the length of remnant rectum and the risk of major LARS was observed in patients treated with combined neoadjuvant therapy and surgery. ConclusionBoth the length of remnant rectum and preoperative chemoradiotherapy had a major impact on the severity of bowel dysfunction after restorative rectal cancer surgery. No functional benefit from an irradiated rectal remnant was observed.

OC-097 An externally validated nomogram to predict the risk of bowel dysfunction following an anterior resection

Introduction Almost half of the patients undergoing an anterior resection for rectal cancer report quality of life impairment due to bowel dysfunction. The Low Anterior Resection Syndrome (LARS) score is an internationally validated patient reported outcome measure (PROM) designed to assess the severity of these symptoms. 1 The aims of this study were to (i) produce a LARS score prediction model based on the risk factors for bowel dysfunction (ii) to validate the model externally and (iii) to incorporate findings into a nomogram for use in clinical practice. Method Patients who were recurrence free and more than one-year post restorative anterior resection (UK, 2001–2011; Denmark, 2001–2007 (median 54 and 56 months since surgery respectively), were invited to complete EORTC QLQ-C30, LARS and Wexner incontinence scores. Demographics, tumour characteristics, pre/post-operative treatment, and surgical procedures were recorded. Advanced linear regression shrinkage techniques (i.e. LASSO) were used independently for both datasets (UK, DK) for an unbiased selection of the most influential factors. Finally a nomogram based on linear regression was generated. Results The model was developed from 463 British patients and validated in 938 Danes. The respective cohorts were similar in gender (females 40% [184/463] versus 43% [402/938] NS) but differed by age (65 [13] versus 64 [13], p = 0.013), pre-operative radiotherapy (31.6% [145/463] versus 20.4% [191/938], p = 0.001), tumour height (median [IQR] 9 cm [4] versus 11 [4], p = 0.001), global quality of life (mean (SD) QLQ C30 Scale, 77 (19) versus 78 (21), p = 0.001) and LARS score (mean (SD) 26.1 (11) versus 24.5 (12), p = 0.012). Tumour height (from the anal verge) and pre-operative radiotherapy were the key variables in the nomogram with several additional factors including age, gender and temporary stoma influencing the predicted LARS score. Conclusion This is the first nomogram to predict patient reported bowel dysfunction following an anterior resection. Despite differences between cohorts, with the UK tending to restore lower tumours and use more pre-operative radiotherapy, we were able to externally validate the model in a Danish population. Colorectal Surgeons and Nurse Specialists may use this predictive tool to help patients understand their risk of bowel dysfunction, it is intended to aid the consent process and highlight patients that may need additional post-operative support. Disclosure of interest None Declared. Reference Juul T, Ahlberg M, Biondo S, et al . International validation of the low anterior resection syndrome (LARS) score. Ann Surg. 2014;259(4):728–34

Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients

PurposeThe low anterior resection syndrome (LARS) score is a simple and valid instrument for measuring bowel dysfunction after sphincter-preserving surgery (SPS) among rectal cancer patients. We aimed to translate the LARS score into Chinese, and to test its reliability and validity among Chinese rectal cancer patients. MethodsThe LARS score was translated into Chinese by using internationally recognized forward- and back-translation procedures. In total, 102 patients completed the questionnaire; a subgroup of 20 patients answered the survey twice. The reliability was estimated through the test-retest reliability method. The convergent and discriminant validities were confirmed by measuring the relation of the LARS score with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29 domains, respectively, and testing its ability to differentiate among patients with different clinical characteristics. ResultsThe Spearman correlation coefficient of the LARS-scores at the two surveys was 0.86 (p < .001), and the linear-weighted kappa values of the five items of the LARS score were 0.38, 0.76, 0.79, 0.77, and 0.78, respectively. The LARS score showed significant correlations with all the assumptive domains of QLQ-C30 and QLQ-CR29, especially flatulence, fecal incontinence, and stool frequency (all p < .05). It could also detect differences between female and male patient groups (p = .033), patients who had/had not undergone radiation therapy (p = .007), those who had undergone surgery in the last <12.0 or ≥12.0 months (p = .002), and those with low or high tumor edge level (p = .017). ConclusionsThe Chinese version of the LARS score had good psychometric properties and can be used in clinical and research settings in the Chinese population.

Redo-surgery by transanal colonic pull-through for failed anastomosis associated with chronic pelvic sepsis or rectovaginal fistula

Redo-surgery with new colorectal (CRA) or coloanal (CAA) anastomosis for failed previous CRA or CAA is exposed to failure and recurrent leakage, especially in case of rectovaginal fistula (RVF) or chronic pelvic sepsis (CPS). In these two situations, transanal colonic pull-through and delayed coloanal anastomosis (DCAA) could be an alternative to avoid definitive stoma. This study aimed to assess results of such redo-surgery with DCAA for failed CRA or CAA with CPS and/or RVF. All patients who underwent DCAA for failed CRA or CAA with CPS and/or RVF were reviewed. Success was defined as a patient without any stoma at the end of follow-up. Long-term functional results were assessed using the low anterior resection syndrome (LARS) score. 24 DCAA were performed after failed CRA or CAA with CPS (n = 15) or RVF (n = 9). Sixteen (67%) patients had a diverting stoma at the time (n = 5) or performed during DCAA (n = 11). After a mean follow-up of 29 ± 19 months, success rate was 79% (19/24): 5 patients had a permanent stoma because of recurrent sepsis (n = 2), anastomotic stricture (n = 1), or poor functional outcomes (n = 2). Functional outcomes were satisfactory (no or minor LARS) in 82% of the successful patients. In case of failed CRA or CAA with CPS or RVF, DCAA was associated with a 79% success rate. It could therefore be proposed as an alternative to standard redo-CRA or CAA when the risk of recurrent sepsis and failure with subsequent definitive stoma is thought to be high.

Bowel Function 14 Years After Preoperative Short-Course Radiotherapy and Total Mesorectal Excision for Rectal Cancer: Report of a Multicenter Randomized Trial

BackgroundWe investigated very long-term bowel function after total mesorectal excision (TME) with or without preoperative short-course radiotherapy (PRT) for rectal cancer, the risk factors for bowel dysfunction, and the association of bowel dysfunction with health-related quality of life (HRQL). Patients and MethodsIn the TME trial (1996-1999), 1530 Dutch patients with rectal cancer were randomized to TME preceded by 5 × 5 Gy PRT or TME alone. A set of questionnaires was sent to the surviving patients (n = 583) in 2012. The questionnaires included the Low Anterior Resection Syndrome Score (LARS score), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) and Colorectal Module (EORTC QLQ-CR29). The LARS score range was divided into “no LARS,” “minor LARS,” and “major LARS” categories in ascending severity of bowel dysfunction. The potential risk factors for major LARS were tested on multivariable analysis. The HRQL was compared between the LARS score categories. ResultsOf the 478 respondents, 242 nonstoma patients were included in the present analysis. The median interval since treatment was 14.6 years, and the median age at the follow-up point was 75 years. Major LARS was reported by 46% of all patients (56% PRT plus TME vs. 35% TME). PRT (odds ratio [OR], 3.0; 99% confidence interval [CI], 1.3-6.9) and age ≤ 75 years at the follow-up point (OR, 2.4; 99% CI, 1.1-5.5) increased the risk of major LARS. Gender, tumor height, anastomotic leakage, type of anastomosis, interval since treatment, and comorbid diabetes were not significant. Patients with major LARS fared worse in many HRQL domains (P < .01; score difference > 5% of score range). ConclusionA considerable proportion of nonstoma patients endured major LARS years after TME. PRT and age ≤ 75 years at follow-up pose further risks of major LARS in addition to surgery. Major LARS is associated with reduced HRQL.

Low anterior resection syndrome and quality of life: an international multicenter study.

An increasing number of patients are surviving a diagnosis of rectal cancer. The majority of the patients are treated with the sphincter-sparing surgical procedure low anterior resection, and 50% to 90% of these patients experience bowel dysfunction, known as the low anterior resection syndrome. No previous studies have investigated the association between the low anterior resection syndrome and quality of life in an international setting with the use of a validated instrument for the classification of the low anterior resection syndrome. The aim of this study was to investigate the association between quality of life and the low anterior resection syndrome in European patients who have had rectal cancer. The study was designed as an international cross-sectional study involving 5 centers in 4 European countries. All patients had undergone low anterior resection for rectal cancer, had no stoma, had no dissemination or recurrence at the time of the study, and were at least 16 months past surgery. The patients received by mail the Low Anterior Resection Syndrome Score and the quality-of-life questionnaire EORTC QLQ-C30. Eight subscales were selected to be the focus of this study: global quality of life; physical, role, emotional, and social functioning; fatigue; constipation; and diarrhea. A total of 796 patients were included, which corresponds to a response rate of 75.0%. In comparison with patients without low anterior resection syndrome, patients with major low anterior resection syndrome fared substantially worse in all selected subscales (difference ≥ 10 points, p < 0.01), with the exception of constipation. The cross-sectional design prevents an evaluation of causality. The quality of life of patients who have had rectal cancer is closely associated with the severity of the low anterior resection syndrome. Therefore, it is important that clinicians and researchers focus on this syndrome to improve the prevention and the treatment of bowel dysfunction and the information given to patients.

International Validation of the Low Anterior Resection Syndrome Score

The aims of this study were to investigate the convergent and discriminative validity and reliability of the low anterior resection syndrome (LARS) score in an international setting. The LARS score is a simple self-administered questionnaire measuring bowel dysfunction after rectal cancer surgery. The score is intended to be commonly used in international research and clinical practice in the future. Therefore, a thorough validation in an international setting is of utmost importance. The LARS score was translated using methods in keeping with current international recommendations. A total of 801 patients operated for rectal cancer in Sweden, Spain, Germany, and Denmark completed the LARS score questionnaire, including an anchor question assessing the impact of bowel function on quality of life. A subgroup of 218 patients completed the LARS score twice. Data were analyzed per country. The LARS score has demonstrated a high convergent validity in terms of a high correlation between LARS score and quality of life (P < 0.001). Sensitivity ranged from 67.7% to 88.3% and specificity from 58.1% to 86.3%. The LARS score was able to discriminate between groups of patients differing with regard to radiotherapy, surgery, and age (P < 0.05). The score also demonstrated high reliability at test-retest with narrow limits of agreement and no statistically significant difference between scores at the first and second test. The Swedish, Spanish, German, and Danish versions of the LARS score have proven to be valid and reliable tools for measuring LARS in European rectal cancer patients.

Bowel dysfunction after rectal cancer treatment: a study comparing the specialist's versus patient's perspective

ObjectivesTo investigate how bowel dysfunction after sphincter-preserving rectal cancer treatment, known as low anterior resection syndrome (LARS), is perceived by rectal cancer specialists, in relation to the patient's experience.DesignQuestionnaire study.SettingInternational.Participants58...

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

Purpose: Thepurposeof this study wastoinvestigatethe relationshipsbetweenanxiety, depression, low anterior resection syndrome, and qualityof life after lower anterior resectionfor rectal cancer. Methods:Theparticipants ofthisstudy were 105 rectal cancer patientswho visitedtheoutpatient departmentof a hospitalin Seoulfor treat- ment or follow-up consultations. Data were collected using self-reportedquestionnaires and clinical records. To measurethevariables, theHospital AnxietyandDepressionScale, Low Anterior ResectionSyndromeScore, and Qualityof LifeQuestionnaire-Core 30wereutilized. Dataweresubsequently analyzed usingtheSPSS/WIN 20.0 program. Results:Low anterior resectionsyndromewas more severeamong patientswhose cancer was located closerto theanus,andhad agreater rangeof resectioninthosewhoreceivedneoadjuvant treatment. Whenanxi- ety, depression, and low anterior resection syndrome score were higher, quality of life scores were lower. Conclusion: These results suggest that low anterior resection syndrome may negatively impact quality of life. Therefore, it is necessary to provide patients with symptom management support/assistance through evi- dence-basednursinginterventions, andevaluations oflow anterior resection syndrometo relieveanxietyandde- pression, and thus enhance quality of life.

Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population‐based cross‐sectional study

Bowel dysfunction was assessed after low anterior resection with and without neoadjuvant therapy (NT) for rectal cancer using a novel symptom-based scoring system correlated with quality of life. We identified all patients who underwent curative resection for rectal cancer in Denmark between 2001 and 2007. A questionnaire on bowel function and quality of life, including the recently validated low anterior resection syndrome score (LARS score; range 0-42) was administered to recurrence-free patients in 2009. We used multivariate analysis to examine the association between major LARS (LARS score ≥ 30) and a number of patient and treatment-related factors. Of 1087 eligible patients, 980 agreed to participate and, of these, 938 were included in the analysis. Major LARS was observed in 41%. The use of NT (OR = 2.48; 95% CI: 1.73-3.55), long-course chemoradiotherapy vs short-course radiotherapy (OR = 0.90; 95% CI: 0.44-1.87), total mesorectal excision (TME) vs partial mesorectal excision (PME) (OR = 2.31; 95% CI: 1.69-3.16), anastomotic leakage (OR = 2.06; 95% CI: 0.93-4.55), age ≤ 64 years at surgery (OR = 1.90; 95% CI: 1.43-2.51) and female gender (OR = 1.35; 95% CI 1.02-1.79) were associated with major LARS. No association was found between major LARS and the time since surgery (OR = 0.78; 95% CI: 0.59-1.04) or neorectal reconstruction (colonic pouch vs straight colorectal or side-to-end anastomosis (OR = 0.96; 95% CI: 0.63-1.46). Severe bowel dysfunction is a frequent long-term outcome after resection for rectal cancer. Use of NT, regardless of a long- or short-course protocol, and TME (compared with PME) are strong independent risk factors for major LARS.

Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer

Bowel dysfunction after sphincter-preserving surgery for rectal cancer is a common complication, with the potential to affect quality of life (QoL) strongly. The aim of this study was to examine the extent of bowel dysfunction and impact on health-related QoL after curative sphincter-preserving resection for rectal cancer. QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, and bowel function using a validated questionnaire, including the recently developed low anterior resection syndrome (LARS) score. Assessments were carried out at the time of diagnosis, and at 3 and 12 months after surgery. A total of 260 patients were included in the study. At 3 months, 58·0 per cent of patients had a LARS score of 30 or more (major LARS), which declined to 45·9 per cent at 12 months (P < 0·001). The risk of major LARS was significantly increased in patients who received neoadjuvant therapy (odds ratio 2·41, 95 per cent confidence interval 1·00 to 5·83), and after total versus partial mesorectal excision (odds ratio 2·81, 1·35 to 5·88). Global health status was closely associated with LARS, and significant differences in global health status, functional and symptom scales of QoL were found between patients without LARS and those with major LARS. Bowel dysfunction is a major problem with an immense impact on QoL following sphincter-preserving resection. The risk of major LARS was significantly increased after neoadjuvant therapy and total mesorectal excision.