Neuromodulation for low-anterior resection syndrome (original) (raw)
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Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer
Rectal Cancer - A Multidisciplinary Approach to Management, 2011
Rectal Cancer-A Multidisciplinary Approach to Management 226 adopted which do not completely rule out continence disorders, but with which they can be largely avoided, or at least reduced, so that they do not significantly affect quality of life. 2. Anal continence disorders 2.1 Anterior resection syndrome, diagnostics Anal continence is a complex function and is made possible by different continence factors with their specific anatomical and physiological substrates (Tab. 1), including the visceral and somatic muscles, the rectum with its reservoir function and the extremely sensitive anoderm, which is capable of discrimination. The continence organ is controlled neurologically at the local spinal and cerebral level. Continence is affected if one of the continence factors, such as discrimination is deficient or the compliance of the remaining rectum or the replacement rectum is deminished. Depending on the cause, anal continence dysfunction, in addition to incontinence in the true sense, can manifest itself in various ways, including in evacuation disorders. This clinical picture is now known as anterior resection syndrome and includes the following symptoms: repetitive imperative urge to defecate post defecation, increased stool frequency, shortened warning period, incomplete bowel movements, fragmented defecation, increased stool frequency due to errors in diet, decreased stool consistency, nocturnal bowel movements, no formed stool, the need for increased abdominal pressure, and incontinence of varying degrees of severity (Tab2 (156). Continence disorders can be objectified with the different continence scores, although the most common ones, such as the Cleveland Clinic Continence Score and the Fecal Index Severity Score (Tab.3), only cover incontinence as such. Scores which also ask about other symptoms, such as discrimination, help to determine both the severity of the incontinence and to localize the causes of the continence disorders or the anterior resection syndrome. A proctologic examination is obligatory for diagnosing continence disorders. Whether further examinations, such as anal sonography, defecation radiography or a dynamic MRT of the pelvis are necessary, will depend on whether the findings have therapeutic consequences.
Anterior resection syndrome : contributing factors and its impact on quality of life
2021
BACKGROUND: In Europe, colorectal cancer is the second most common cancer in women and third most common in men. Around half of all colorectal cancer cases affect the rectum. Surgery is the main curative therapy for rectal cancer however this is associated with bowel functional disturbances post anterior resection. The wide spectrum of symptoms following resection and restitution of rectum is what constitutes anterior resection syndrome.METHODS: Adult patients who had undergone anterior resection between January 2014 and December 2016 were recruited. Variable factors for LARS were collected retrospectively from clinical records. Data was collected using validated questionnaires, namely LARS scale and EORTC QLQ-C30. Statistical analysis included ordinal logistic regression, one-way ANOVA and Scheffe post-hoc test.RESULTS: Between January 2014 and December 2016, 179 patients had undergone anterior resection, with 55 patients fulfilling the inclusion criteria. Symptoms of LARS were ide...
BMC Gastroenterology, 2024
Background Rectal cancer is commonly treated by chemoradiation therapy, followed by the low anterior resection anal sphincter-preserving surgery, with a temporary protecting ileostomy. After reversal of the stoma a condition known as low anterior resection syndrome (LARS) can occur characterized by a combination of symptoms such as urgent bowel movements, lack of control over bowel movements, and difficulty fully emptying the bowels. These symptoms have a significant negative impact on the quality of life for individuals who have survived the cancer. Currently, there is limited available data regarding the presence, risk factors, and effects of treatment for these symptoms during long-term follow-up. Aims To evaluate long term outcomes of low anterior resection surgery and its correlation to baseline anorectal manometry (ARM) parameters and physiotherapy with anorectal biofeedback (BF) treatment. Methods One hundred fifteen patients (74 males, age 63 ± 11) who underwent low anterior resection surgery for rectal cancer were included in the study. Following surgery, patients were managed by surgical and oncologic team, with more symptomatic LARS patients referred for further evaluation and treatment by gastroenterologists. At follow up, patients were contacted and offered participation in a long term follow up by answering symptom severity and quality of life (QOL) questionnaires. Results 80 (70%) patients agreed to participate in the long term follow up study (median 4 years from stoma reversal, range 1-8). Mean time from surgery to stoma closure was 6 ± 4 months. At long term follow up, mean LARS score was 30 (SD 11), with 55 (69%) patients classified as major LARS (score > 30). Presence of major LARS was associated with longer time from surgery to stoma reversal (6.8 vs. 4.8 months; p = 0.03) and with adjuvant chemotherapy (38% vs. 8%; p = 0.01). Patients initially referred for ARM and BF were more likely to suffer from major LARS at long term follow up (64% vs. 16%, p < 0.001). In the subgroup of patients who underwent perioperative ARM (n = 36), higher maximal squeeze pressure, higher maximal incremental squeeze pressure and higher rectal pressure on push were all associated with better long-term outcomes of QOL parameters (p < 0.05 for all). 21(54%) of patients referred to ARM were treated with BF, but long term outcomes for these patients were not different from those who did not perform BF. Conclusions A significant number of patients continue to experience severe symptoms and a decline in their quality of life even 4 years after undergoing low anterior resection surgery. Prolonged time until stoma reversal and adjuvant chemotherapy emerged as the primary risk factors for a negative prognosis. It is important to note that referring
International Journal of Colorectal Disease, 2013
Background It was the aim of this prospective study to analyze both feasibility and effectiveness of sacral neuromodulation for fecal incontinence and "low anterior resection syndrome" following neoadjuvant therapy for rectal cancer. Methods All patients who underwent sacral neuromdulation following neoadjuvant therapy for rectal cancer (preoperative radiochemotherapy, oncologic rectal resection with total mesorectal excision) were prospectively enrolled in the study. Only patients with failure of conservative treatment and without any evidence of residual or recurrent tumor disease were candidates for sacral neuromdulation which was performed by a two-stage procedure (diagnostic percutaneous test stimulation followed by definite implant). In addition to feasibility, primary end points included success (reduction of incontinent episodes), continence and defecation status (assessed by Cleveland Clinic Incontinence Score and Altomare score), and quality of life (EQ-5D). Anal manometry was performed preoperative and at 12-month follow-up. Follow-up information was derived from clinical examination 3, 6, and 12 months postoperatively. Results Nine patients (three females, six males) with a mean age of 61 years underwent sacral neuromodulation following neoadjuvant therapy for rectal cancer. Implantation rate was 100 %. No septic morbidity was observed. After a mean follow-up of 12 months, mean Cleveland Clinic Incontinence Score was reduced from 18.2 to 6.0 (p<0.01). Incontinence episodes were significantly reduced from 7 to 0.5 (per day) and 20 to 8 (per week). Fecal urgency, fragmented defecation, and soiling were improved or resolved in two thirds. Altomare score was significantly reduced from 21.0 to 9.3 (p<0.01). Anorectal manometry did not correlate with clinical success. Quality of life was significantly improved (EQ-5D generic: 0.42 vs. 0.74, EQ-5D-VAS score: 20 vs. 90, p<0.01). Conclusions Preliminary results of sacral neuromodulation in patients with fecal incontinence and symptoms of "low anterior resection syndrome" are promising and enrich the therapeutic modalities if conservative management has failed.
International Journal of Colorectal Disease, 2019
Purpose Treatment of rectal cancer often results in disturbed anorectal function, which can be quantified by the Low Anterior Resection Syndrome (LARS) score. This study investigates the association of impaired anorectal function as measured with the LARS score with quality of life (QoL) as measured with the EORTC-QLQ-C30 and CR38 questionnaires. Methods All stoma-free patients who had undergone sphincter-preserving surgery for rectal cancer from 2000 to 2014 in our institution were retrieved from a prospective database. They were contacted by mail and asked to return the questionnaires. QoL was evaluated in relation to LARS and further patient-and treatment factors using univariate and multivariate analysis. Results Of the eligible patients (n = 331), 261 (78.8%) responded with a complete LARS score. Mean score for global QoL according to the EORTC-QLQ-C30 questionnaire was 63 ± 21 for all patients. If major LARS was present, mean score decreased to 56 ± 19 in contrast to 67 ± 20 in patients with no/minor LARS (p < 0.001). In regression analysis, major LARS was furthermore associated with reduced physical, role, emotional, cognitive and social functioning as well as impaired body image, more micturition problems and poorer future perspective. It was not related to sexual function. The variance explained by major LARS in the differences of QoL was approximately 10%. Conclusion The presence of major LARS after rectal resection for cancer is negatively associated with global health as well as many other aspects of QoL. Preserving anorectal function and treatment of LARS are potential measures to improve QoL in this patient group.
Long-term bowel dysfunction following low anterior resection
Scientific Reports
Study aimed to assess long-term bowel function in patients who underwent low anterior resection for cancer five and more years ago. Patients who underwent low anterior resection for rectal cancer from 2010 to 2015 at National Cancer Institute were prospectively included in our study. They were interviewed using low anterior resection syndrome (LARS) score and Wexner questionnaire. We also assessed possible risk factors of postoperative bowel disorder. 150 patients were included in our study. Of them 125 (83.3%) were analysed. The median age at diagnosis was 62 years (40–79), and the average time of follow-up was 7.5 years (5–11). Overall, 58 (46.4%) patients had LARS, of them 33 (26.4%)—major LARS and 25 (20%)—minor LARS and 67 (53.6%) reported no LARS. Wexner score results were: normal in 43 (34.4%) patients, minor faecal incontinence—55 (44%), average faecal incontinence—18 (14.4%), complete faecal incontinence—9 (7.2%). 51 patients (40.8%) had tumour in the upper third rectum, 51...