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Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study.

ABSTRACT: BACKGROUND:The prevalence of major low anterior resection syndrome (LARS) after rectal cancer surgery varies from 17·8 to 56·0 per cent, but data from high-quality studies are sparse. The aim of this study was to determine the prevalence of LARS and its association with quality of life (QoL) in a large, well defined, population-based cohort. METHODS:This was a population-based study that included all patients who had curative rectal cancer surgery with total or partial mesorectal excision in Stockholm County in Sweden between 2007 and 2013. Patients without a remaining stoma, free from cancer and alive in April 2017 were eligible for the study. The LARS score questionnaire, EORTC QLQ-C30 and Cleveland Clinic Florida Fecal Incontinence score were used as outcome measures. Adjusted mean scores (and differences) of EORTC QLQ-C30 for LARS groups were calculated using repeated measures ANCOVA regression models while adjusting for predefined confounders. RESULTS:In total, 481 patients (82·6 per cent response rate) were included in the analysis. Mean follow-up time was 6·7 (range 3·4-11·0) years after surgery. The prevalence of LARS was 77·4 per cent (370 of 478 patients), with 53·1 per cent (254 of 478) experiencing major LARS. Patients with major LARS reported worse on all EORTC QLQ-C30 subscales (except for financial difficulties) than patients without LARS. A higher mean LARS score was associated with a greater impact on bowel-related QoL. CONCLUSION:After anterior resection for rectal cancer, the majority of patients suffer from major LARS with a negative impact on QoL.

SUBMITTER: Pieniowski EHA

PROVIDER: S-EPMC7528525 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study.

Pieniowski E H A EHA Nordenvall C C Palmer G G Johar A A Tumlin Ekelund S S Lagergren P P Abraham-Nordling M M

BJS open 20200612 5

<h4>Background</h4>The prevalence of major low anterior resection syndrome (LARS) after rectal cancer surgery varies from 17·8 to 56·0 per cent, but data from high-quality studies are sparse. The aim of this study was to determine the prevalence of LARS and its association with quality of life (QoL) in a large, well defined, population-based cohort.<h4>Methods</h4>This was a population-based study that included all patients who had curative rectal cancer surgery with total or partial mesorectal ...[more]

PMID: 32530135

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Project description:BackgroundThe long-term effects of radical resection on quality of life may influence the treatment selection. The objective of this study was to determine whether abdominoperineal resection has a better effect on the quality of life than sphincter preservation surgery at 3 years after surgery.MethodsThis prospective, cohort study included patients who underwent radical resection for low rectal cancer. The primary outcomes were European Organisation for Research and Treatment of Cancer QLQ-C30 and CR38 quality of life scores 3 years after surgery, which were compared with linear generalised estimating equations, after adjustment for baseline values, a time effect, and an interaction effect between time and treatment. The secondary outcomes included sexual-urinary functions and oncological outcomes. The study was registered with ClinicalTrials.gov (NCT01461525).FindingsBetween December 2011 and August 2016, 342 patients were enrolled: 268 (78•4%) underwent sphincter preservation surgery and 74 (21•6%) underwent abdominoperineal resection. The global quality of life scores did not differ between sphincter preservation surgery and abdominoperineal resection groups (adjusted mean difference, 4•2 points on a 100-point scale; 95% confidence interval [CI], -1•3 to 9•7, p = 0•1316). Abdominoperineal resection was associated with a worse body image (9•8 points; 95% CI, 2•9 to 16•6, p = 0•0052), micturition symptoms (-8•0 points; 95% CI, -14•1 to -1•8, p = 0•0108), male sexual problems (-19•9 points; 95% CI, -33•1 to -6•7, p = 0•0032), less confidence in getting and maintaining an erection in males (0•5 points on a 5-point scale; 95% CI, 0•1 to 0•8, p = 0•0155), and worse urinary symptoms (-5•4 points on a 35-point scale; 95% CI, -8•0 to -2•7, p < 0•0001). The 5-year overall survival was worse with abdominoperineal resection in unadjusted (92•2% vs 80•9%; difference 11•3%, hazard ratio 2•38; 95% CI, 1•27 to 4•46, p = 0•0052), but did not differ after adjustment.InterpretationIn this long-term prospective study, abdominoperineal resection failed to meet the superiority to sphincter preservation surgery in terms of quality of life. Although the global quality of life scores did not differ between groups, this study suggests that sphincter preservation surgery can be an acceptable alternative to abdominoperineal resection for low rectal cancer, offering a better quality of life and sexual-urinary functions, with no increased oncological risk even after 3 years.FundingSeoul National University Bundang Hospital, Korea.

Project description:BackgroundLow anterior resection syndrome is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The low anterior resection syndrome score was designed as a simple tool for clinical evaluation of low anterior resection syndrome. Although the low anterior resection syndrome score has good clinical utility, it may not capture all important aspects that patients may experience.ObjectiveThe aim of this collaboration was to develop an international consensus definition of low anterior resection syndrome that encompasses all aspects of the condition and is informed by all stakeholders.DesignThis international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting.ParticipantsThree expert groups participated: patients, surgeons, and other health professionals from 5 regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in 3 languages (English, Spanish, and Danish).Main outcome measureThe primary outcome measured was the priorities for the definition of low anterior resection syndrome.ResultsThree hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96%, and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to 8 symptoms and 8 consequences that capture essential aspects of the syndrome.LimitationsSampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this.ConclusionsThis is the first definition of low anterior resection syndrome developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of low anterior resection syndrome. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in low anterior resection syndrome over time and with intervention.

Dataset Information

Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study.

Publications

Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study.

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