Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus (original) (raw)
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Turkish Journal of Colorectal Disease
Aim: Low anterior resection (LAR) and intersphincteric resection (ISR) are the standard surgical options for low and very low rectal cancers, respectively. Unlike LAR, dissection in between the internal and external sphincter in ISR may functionally compromise sphincter integrity postsurgery. The aim was to compare anal sphincter function using anorectal manometry (ARM) in patients undergoing LAR and ISR, prior to stoma closure. Method: Retrospective review of 50 cases of rectal cancer operated between January 2017 to October 2019 and referred for ARM before stoma closure. Patients with anorectal dysfunction were referred for physiotherapy and reassessed. Results: Of the 50 patients, 25 patients had undergone LAR and 25 patients had undergone ISR. No difference was seen between the groups with relation to mean Cleveland Clinic Florida Fecal Incontinence Score [(CCFFIS); 4.76±2.93 vs. 5.28±3.57], mean resting pressure (56.22±15.48 vs. 51.10±19.83 mmHg), mean squeeze pressure (128.68±47.15 vs. 126.09±41.90 mmHg) and mean squeeze duration (25.98±10.90 vs. 24.55±13.12 seconds). In the LAR and ISR groups 8/25 (32%) and 11/25 (44%) had inadequate sphincter function on manometry (p>0.05). Significantly lower squeeze pressure (145.36±43.30 vs. 114.37±40.70 mmHg) and higher CCFFIS score was seen in those patients who underwent ARM a year after surgery. Conclusion: Both ISR and LAR had similar losses in anal sphincter function, with greater degree of dysfunction in patients having stoma for a prolonged period.
Correlation Between the Level of Colorectal Anastomosis and Anorectal Function
Acta Clinica Croatica, 2020
Anterior rectal resection is a standard surgical procedure for treating carcinomas of rectum and distal sigmoid colon. In many cases of anterior rectal resection, postoperatively some level of fecal incontinence may occur. The aim of our study was to evaluate the impact of the colorectal anastomosis level on anorectal functional disorder. In our prospective study, the participants were patients diagnosed with carcinoma of rectum or distal sigmoid colon. All patients underwent standard open or laparoscopic anterior rectal resection. Six months after the surgery, the function of anorectum was evaluated in all participants. Finally, 38 patients were analyzed, including 13/38 (34.2%) patients with high rectal anastomosis, 11/38 (28.9%) with mid rectal anastomosis and 14/38 (36.8%) with low rectal anastomosis. Patients with a lower level of anastomosis had a statistically significantly greater number of stools, higher urgency and discrimination impairment, more pronounced solid, liquid and gas incontinence, and greater need for diapers (p<0.05 all). Therefore, patients with lower anastomosis had a statistically significant impairment of their quality of life and higher Wexner score (p<0.001 for both analyses). Our study results suggested reduced neorectal capacity to be the main pathophysiological factor for the development of postoperative anorectal function impairment.
Background Rectal cancer is commonly treated by chemo-radiation therapy, followed by anal sphincter-preserving surgery, with a temporary protecting ileostomy. After the 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 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 sphincter-preserving surgery and its correlation to baseline anorectal manometry (ARM) parameters and physiotherapy with anorectal biofeedback (BF) treatment. Methods 115 patients (74 males, age 63 ± 11) who underwent sphincter preserving surgery for rectal cancer were in...
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
Caspian Journal of Internal Medicine, 2022
Background: Fecal incontinence is the main morbidity of inter-sphincteric resection (ISR) in ultra-low rectal cancer. Malone Ante grade Continence Enema (MACE) has been proposed for these patients. We aimed to compare the quality of life outcomes in cases with ultra-low rectal cancer who had undergone ISR±MACE. Methods: The current randomized clinical study was accomplished for two years from December 2016 to February 2018 in Imam Khomeini Hospital (Sari City, I.R.Iran) on 30 patients (15 in each group) with rectal cancer. The inclusion criteria of the study were stage 1 and 2a of low rectal cancer with type 2 and 3 of Rullier's classification, those who received neoadjuvant chemo radiotherapy. The exclusion criteria were comorbidity diseases, immune deficiency, poor follow-up. The follow-up period was one year. The Quality of Life (Qol) was reported as primary endpoint. The EORTC QLQ-C30 score and Wexner questionnaires were used. SPSS Version 22 was used. A p-value less than 0.05 was considered statistically significant. Results: The mean age of patients was 56.23±8.72 years. The overall Qol score was better in the ISR-MACE (P=0.023). The overall Qol was lower in women than in men in both groups. Low anterior resection syndrome score was lower in the ISR plus MACE group than the ISR group (P=0.030). The Wexner score revealed better scores in the ISR with MACE group than the ISR without MACE group (p<0.0001). Conclusion: Patients who underwent ISR plus MACE surgery had better defecation control and better quality of life than patients without MACE.
Annals of Coloproctology, 2015
Purpose: After total mesorectal excision (TME) with primary anastomosis for patients with rectal cancer, the quality of life (QoL) may be decreased due to fecal incontinence. This study aimed to identify predictors of fecal incontinence and related QoL. Methods: Patients who underwent TME with primary anastomosis for rectal cancer between December 2008 and June 2012 completed the fecal incontinence quality of life scale (FIQoL) and Wexner incontinence score. Factors associated with these scores were identified using a linear regression analysis. Results: A total of 80 patients were included. Multivariate analysis identified a diverting ileostomy (n = 58) as an independent predictor of an unfavorable outcome on the FIQoL subscale coping/behavior (P = 0.041). Ileostomy closure within and after 3 months resulted in median Wexner scores of 5.0 (interquartile range [IQR], 2.5-8.0) and 10.5 (IQR, 6.0-13.8), respectively (P < 0.001). The median FIQoL score was 15.0 (IQR, 13.1-16.0) for stoma closure within 3 months versus 12.0 (IQR, 10.5-13.9) for closure after 3 months (P = 0.001). Conclusion: A diverting ileostomy is a predictor for an impaired FIQoL after a TME for rectal cancer. Stoma reversal within 3 months showed better outcomes than reversal after 3 months. Patients with a diverting ileostomy should be informed about the impaired QoL, even after stoma closure.
Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results
Cancer Survivorship, 2019
Intersphincteric resections are part of the therapeutic arsenal that preserves the sphincterian apparatus. This chapter analyzes the evolution of rectal surgery leading up to intersphincteric resections, deals with anatomical and oncological aspects in rectal cancer, and finally shows our own personal experience with ISR in a series of 40 cases focusing on oncological outcomes, continence, and defecation. As a conclusion, intersphincteric resection represents a feasible therapeutic option in highly selected cases that exempts the patient from the need of a permanent colostomy bag without compromising oncological principles. The Wexner score system is simple and effective in objectifying continence in patients that undergo this type of surgery.