Daniel Ll Hughes1, Julie Cornish2, Chris Morris1. 1. Department of Colorectal Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK. 2. Department of Colorectal Surgery, Royal Glamorgan Hospital, Llantrisant, CF72 8XR, UK. julie.cornish@wales.nhs.uk.
Abstract
PURPOSE: Developments in surgical techniques and neoadjuvant treatment have enabled an increasing proportion of patients with rectal cancer to undergo sphincter-sparing resections. The avoidance of a permanent stoma can come at the cost of poor bowel function which can significantly impact patients' quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal cancer surgery. METHODS: Patients undergoing anterior resection for rectal cancer between January 2009 and January 2015 were identified from a rectal cancer database at a single centre. All patients who had bowel continuity restored and underwent curative resection were sent a validated low anterior resection syndrome (LARS) questionnaire. Pre-, inter- and postoperative factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression. RESULTS: There was an 80% response rate (n = 68). Thirty-eight patients (56%) had major LARS symptoms. Neoadjuvant radiotherapy, predominantly long-course chemoradiotherapy (LCCRT), was an independent risk factor for development of major LARS symptoms, while restoration of bowel continuity within 6 months was protective. CONCLUSIONS: The use of neoadjuvant radiotherapy (LCCRT) and timing of stoma reversal are risk factors for the development of severe bowel dysfunction. The potential for long-term poor functional results after LCCRT should be discussed with patients and form a part of the decision-making in individual treatment plans. The timing of the ileostomy closure, where safe and feasible, should be performed within 6 months to improve outcome.
PURPOSE: Developments in surgical techniques and neoadjuvant treatment have enabled an increasing proportion of patients with rectal cancer to undergo sphincter-sparing resections. The avoidance of a permanent stoma can come at the cost of poor bowel function which can significantly impact patients' quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal cancer surgery. METHODS:Patients undergoing anterior resection for rectal cancer between January 2009 and January 2015 were identified from a rectal cancer database at a single centre. All patients who had bowel continuity restored and underwent curative resection were sent a validated low anterior resection syndrome (LARS) questionnaire. Pre-, inter- and postoperative factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression. RESULTS: There was an 80% response rate (n = 68). Thirty-eight patients (56%) had major LARS symptoms. Neoadjuvant radiotherapy, predominantly long-course chemoradiotherapy (LCCRT), was an independent risk factor for development of major LARS symptoms, while restoration of bowel continuity within 6 months was protective. CONCLUSIONS: The use of neoadjuvant radiotherapy (LCCRT) and timing of stoma reversal are risk factors for the development of severe bowel dysfunction. The potential for long-term poor functional results after LCCRT should be discussed with patients and form a part of the decision-making in individual treatment plans. The timing of the ileostomy closure, where safe and feasible, should be performed within 6 months to improve outcome.
Authors: Anne K Danielsen; Jennifer Park; Jens E Jansen; David Bock; Stefan Skullman; Anette Wedin; Adiela Correa Marinez; Eva Haglind; Eva Angenete; Jacob Rosenberg Journal: Ann Surg Date: 2017-02 Impact factor: 12.969
Authors: Wilhelmina S Visser; Wouter W Te Riele; Djamila Boerma; Bert van Ramshorst; Henderik L van Westreenen Journal: Ann Coloproctol Date: 2014-06-23
Authors: H Jervoise N Andreyev; Barbara E Benton; Amyn Lalji; Christine Norton; Kabir Mohammed; Heather Gage; Kjell Pennert; James O Lindsay Journal: Lancet Date: 2013-09-23 Impact factor: 79.321
Authors: Flavius Sandra-Petrescu; Florian Herrle; Axel Hinke; Inga Rossion; Heiko Suelberg; Stefan Post; Ralf-Dieter Hofheinz; Peter Kienle Journal: BMC Cancer Date: 2015-11-21 Impact factor: 4.430
Authors: S Y Parnasa; H Chill; B Helou; A Cohen; R Alter; D Shveiky; I Mizrahi; M Abu-Gazala; A J Pikarsky; N Shussman Journal: Tech Coloproctol Date: 2022-09-12 Impact factor: 3.699
Authors: R Hompes; J A Cornish; I Vogel; N Reeves; P J Tanis; W A Bemelman; J Torkington Journal: Tech Coloproctol Date: 2021-04-01 Impact factor: 3.781
Authors: Peter G Vaughan-Shaw; Katherine Gash; Katie Adams; Abigail E Vallance; Sophie A Pilkington; Jared Torkington; Julie A Cornish Journal: BMJ Open Date: 2018-10-15 Impact factor: 2.692
Authors: Michał M Nowakowski; Mateusz Rubinkiewicz; Natalia Gajewska; Grzegorz Torbicz; Michał Wysocki; Piotr Małczak; Piotr Major; Mateusz Wierdak; Andrzej Budzyński; Michał Pędziwiatr Journal: Wideochir Inne Tech Maloinwazyjne Date: 2018-07-03 Impact factor: 1.195
Authors: C Keane; J Park; S Öberg; A Wedin; D Bock; G O'Grady; I Bissett; J Rosenberg; E Angenete Journal: Br J Surg Date: 2019-02-01 Impact factor: 6.939