#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Low anterior resection syndrome


Authors: P. Kocian;  J. Hoch
Authors‘ workplace: Chirurgická klinika 2. LF UK a FN Motol, přednosta: prof. MUDr. J. Hoch, CSc.
Published in: Rozhl. Chir., 2015, roč. 94, č. 3, s. 96-102.
Category: Review

Overview

The most important quality parameters of rectal cancer surgery are oncological radicality, postoperative complications, recurrence rate and survival. Rectal dysfunction following low anterior resection occurs in up to 25–50% of patients. Despite its high frequency, however, it does not receive enough attention. Rectal dysfunction after surgery includes frequent bowel movements, urgency, incomplete evacuation, incontinence or sexual and urinary dysfunctions. The complex of symptoms is collectively referred to as the low anterior resection syndrome – LARS. In this review, we discuss the alterations in anorectal physiology after low anterior resection, the etiology and risk factors of LARS, different types of neorectal reservoir construction, and various options for prevention and treatment of LARS. Furthermore, sexual and urinary dysfunction is briefly reviewed.

Keywords:
low anterior resection − bowel dysfunction − incontinence − anorectal physiology


Sources

1. Havenga K, Enker WE, Norstein J, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 1999;25:368−74.

2. Heald RJ, Moran BJ, Ryall RD, et al. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg 1998;133:894−9.

3. Folkesson J, Birgisson H, Pahlman L, et al. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005;23:5644–50.

4. Wong RK, Tandan V, De Silva S, et al. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev 2007;2:CD002102.

5. Hoch J. Maligní nádory konečníku. In: Antoš F, et al. Koloproktologie II. díl. 1. vyd. Praha, Institut postgraduálního vzdělávání ve zdravotnictví 2013:33−44.

6. Kala Z, Tomášek J, Šlampa P, et al. Komplexní léčba karcinomu rekta. Postgraduální medicína 2014;3:19−28.

7. Rao GN, Drew PJ, Lee PW, et al. Anterior resection syndrome is secondary to sympathetic denervation. Int J Colorectal Dis 1996;11:250−8.

8. Hallbook O, Sjodahl R. Surgical approaches to obtaining optimal bowel function. Semin Surg Oncol 2000;18:249−58.

9. Efthimiadis C, Basdanis G, Zatagias A, et al. Manometric and clinical evaluation of patients after low anterior resection for rectal cancer. Tech Coloproctol 2004;8,Suppl 1:205−7.

10. Kakodkar R, Gupta S, Nundy S. Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome. Colorectal Dis 2006;8:650−6.

11. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 2012;255:922−8.

12. Bregendahl S, Emmertsen KJ, Lous J, et al. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis 2013;15:1130−9.

13. Szynglarewicz B, Zietek M, Forgacz J, et al. Urinary complications in rectal cancer patients are related to the dissection tool. Hepatogastroenterology 2012;59:724−6.

14. Ho VP, Lee Y, Stein SL, et al. Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum 2011;54:113−25.

15. Morihiro M, Koda K, Seike K, et al. Characteristic findings on defecography according to reconstruction method and defecatory disorder following sphincter-saving surgery for rectal cancer. Int J Colorectal Dis 2008;23:883−92.

16. Pucciani F. A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updates Surg 2013;65:257−63.

17. Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil 2006;18:507−19.

18. Farouk R, Duthie GS, Lee PW, et al. Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up. Dis Colon Rectum 1998;41:888−91.

19. Ho YH, Tsang C, Tang CL, et al. Anal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal manometry. Dis Colon Rectum 2000;43:169−73.

20. Stebbing, JF, Brading AF, Mortensen NJ. Nitric oxide and the rectoanal inhibitory reflex: retrograde neuronal tracing reveals a descending nitrergic rectoanal pathway in a guinea-pig model. Br J Surg 1996;83:493−8.

21. O‘Riordain MG, Molloy RG, Gillen P, et al. Rectoanal inhibitory reflex following low stapled anterior resection of the rectum. Dis Colon Rectum 1992;35:874−8.

22. Horgan AF, Molloy RG, Coulter J, et al. Nerve regeneration across colorectal anastomoses after low anterior resection in a canine model. Int J Colorectal Dis 1993;8:167−9.

23. Sagar PM, Holdsworth PJ, Johnston D. Correlation between laboratory findings and clinical outcome after restorative proctocolectomy: serial studies in 20 patients with end-to-end pouch-anal anastomosis. Br J Surg 1991;78:67−70.

24. Bassotti G, de Roberto G, Chistolini F, et al. Case report: colonic manometry reveals abnormal propulsive behaviour after anterior resection of the rectum. Dig Liver Dis 2005;37:124−8.

25. Ziv Y, Zbar A, Bar-Shavit Y, et al. Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations. Tech Coloproctol 2013;17:151−62.

26. Varma JS, Smith AN, Busuttil A. Function of the anal sphincters after chronic radiation injury. Gut 1986;27:528−33.

27. Da Silva GM, Berho M, Wexner SD, et al. Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum 2003;46:1492−7.

28. Lim JF, Tjandra JJ, Hiscock R, et al. Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency. Dis Colon Rectum 2006;49:12−9.

29. Frykholm GJ, Sintorn K, Montelius A, et al. Acute lumbosacral plexopathy during and after preoperative radiotherapy of rectal adenocarcinoma. Radiother Oncol 1996;38:121−30.

30. Birgisson H, Påhlman L, Gunnarsson U, et al. Late adverse effects of radiation therapy for rectal cancer - a systematic overview. Acta Oncol 2007;46:504−16.

31. Kollmorgen CF, Meagher AP, Wolff BG, et al. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;220:676−82.

32. Dahlberg M, Glimelius B, Graf W, et al. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 1998;41:discussion 549−51.

33. Birnbaum EH, Myerson RJ, Fry RD, et al. Chronic effects of pelvic radiation therapy on anorectal function. Dis Colon Rectum 1994;37:909−15.

34. Gervaz P, Rotholtz N, Pisano M, et al. Quantitative short-term study of anal sphincter function after chemoradiation for rectal cancer. Arch Surg 2001;136:192−6.

35. van Duijvendijk P, Slors JF, Taat CW, et al. Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 2002;97:2282−9.

36. Emmertsen KJ, Laurberg S. Bowel dysfunction after treatment for rectal cancer. Acta Oncol 2008;47:994−1003.

37. Pollack J, Holm T, Cedermark B, et al. Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 2006;49:345−52.

38. Lundby L, Jensen VJ, Overgaard J, et al. Long-term colorectal function after postoperative radiotherapy for colorectal cancer. Lancet 1997;350:564.

39. Lundby L, Krogh K, Jensen VJ, et al. Long-term anorectal dysfunction after postoperative radiotherapy for rectal cancer. Dis Colon Rectum 2005;48: discussion 1349−52, author reply 1352.

40. Peeters KC, van de Velde CJ, Leer JW, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 2005;23: 6199−206.

41. Barrier A, Martel P, Gallot D, et al. Long-term functional results of colonic J pouch versus straight coloanal anastomosis. Br J Surg 1999;86:1176−9.

42. Machado M, Nygren J, Goldman S, et al. Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg 2003;238:214−20.

43. Jiang JK, Yang SH, Lin JK. Transabdominal anastomosis after low anterior resection: A prospective, randomized, controlled trial comparing long-term results between side-to-end anastomosis and colonic J-pouch. Dis Colon Rectum 2005;48:discussion 2108−10.

44. Liao C, Gao F, Cao Y, et al. Meta-analysis of the colon J-pouch vs transverse coloplasty pouch after anterior resection for rectal cancer. Colorectal Dis 2010;12:624−31.

45. Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev 2008;2:CD006040.

46. Remzi FH, Fazio VW, Gorgun E, et al. Quality of life, functional outcome, and complications of coloplasty pouch after low anterior resection. Dis Colon Rectum 2005;48:735−43.

47. Tsunoda A, Kamiyama G, Narita K, et al. Prospective randomized trial for determination of optimum size of side limb in low anterior resection with side-to-end anastomosis for rectal carcinoma. Dis Colon Rectum 2009;52:1572−7.

48. Hallbook O, Påhlman L, Krog M, et al. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 1996;224:58−65.

49. Koh PK, Tang CL, Eu KW, et al. A systematic review of the function and complications of colonic pouches. Int J Colorectal Dis 2007;22:543−8.

50. Joo JS, Latulippe JF, Alabaz O, et al. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained? Dis Colon Rectum 1998;41:740−6.

51. de la Fuente SG, Mantyh CR. Reconstruction techniques after proctectomy: what‘s the best? Clin Colon Rectal Surg 2007;20:221−30.

52. Furst A, Burghofer K, Hutzel L, et al. Neorectal reservoir is not the functional principle of the colonic J-pouch: the volume of a short colonic J-pouch does not differ from a straight coloanal anastomosis. Dis Colon Rectum 2002;45:660−7.

53. Hida J, Yasutomi M, Fujimoto K, et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size. Dis Colon Rectum 1996;39:986−91.

54. Ho YH, Yu S, Ang ES, et al. Small colonic J-pouch improves colonic retention of liquids--randomized, controlled trial with scintigraphy. Dis Colon Rectum 2002;45:76−82.

55. Lazorthes F, Gamagami R, Chiotasso P, et al. Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum 1997;40:1409−13.

56. McGlone ER, Khan OA, Conti J, et al. Functional outcomes following laparoscopic and open rectal resection for cancer. Int J Surg 2012;10:305−9.

57. Maris A, Devreese AM, D‘Hoore A, et al. Treatment options to improve anorectal function following rectal resection: a systematic review. Colorectal Dis 2013;15:e67−78.

58. Hanauer SB. The role of loperamide in gastrointestinal disorders. Rev Gastroenterol Disord 2008;8:15−20.

59. Ho YH, Chiang JM, Tan M, et al. Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy. Dis Colon Rectum 1996;39: 1289−92.

60. Pucciani F, Ringressi MN, Redditi S, et al. Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results. Dis Colon Rectum 2008;51:1552−8.

61. Allgayer H, Dietrich CF, Rohde W, et al. Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol 2005;40:1168−75.

62. Koch SM, Rietveld MP, Govaert B, et al. Retrograde colonic irrigation for faecal incontinence after low anterior resection. Int J Colorectal Dis 2009;24:1019−22.

63. Gosselink MP, Darby M, Zimmerman DD, et al. Long-term follow-up of retrograde colonic irrigation for defaecation disturbances. Colorectal Dis 2005;7:65−9.

64. Šlauf P. Anální inkontinence. Postgraduální medicína 2000;4:422−28.

65. Mrkos D. Sexuální dysfunkce po chirurgických výkonech. Postgraduální medicína 2008;4:403−410.

66. Antoš F, Hoch J. Sexuální poruchy po kolorektálních operacích. Rozhl Chir 1989;68:55−61.

67. Hendren SK, O‘Connor BI, Liu M, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005;242:212−23.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#