Dataset Information

Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life.

ABSTRACT: To identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504-43.958, p?=?0.002), low anastomosis (OR: 10.492, 95% CI: 2.504-43.958, p?=?0.001), and complications (OR: 2.163, 95% CI: 1.100-4.255, p?=?0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

SUBMITTER: Kim MJ

PROVIDER: S-EPMC7878496 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life.

Kim Min Jung MJ Park Ji Won JW Lee Mi Ae MA Lim Han-Ki HK Kwon Yoon-Hye YH Ryoo Seung-Bum SB Park Kyu Joo KJ Jeong Seung-Yong SY

Scientific reports 20210211 1

To identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variab ...[more]

PMID: 33574345

Similar Datasets

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.

Project description:Interventions: This is a prospective randomised controlled study comparing colesevelam therapy with placebo in a two-period cross-over design, where patients will act as their own controls. Radiological testing for Bile acid malabsorption (BAM) will be performed in a subset of participants prior to the intervention being administered. We aim to test at least half of the participants, but this will be determined by funding and access to radiology. We anticipate that 3-15 patients will undergo this test. Selection will be based on the test being available when the individual is recruited. The SeHCAT test involves administering 75Se 23-selena-25-homocholic acid and glycocholic acid as an oral capsule to a fasting patient. The initial count rate of 75Se will be measured three hours after the intake of the isotope. On day 7 following administration, there will be further imaging, and the net count rate of 75Se will be expressed as a percentage of the net count rate at day 0. The % retention of 75Se will be recorded. While a positive test is one that shows a retention <15%, the actual levels of 75Se will also be compared to changes in the LARS score. A 2-sequence, 2-period design will be used with a six-week washout between interventions to account for first-order carryover effects. Participants will be randomised to one of the following sequences: AB|BA, where A=colesevelam therapy and B=placebo. The intervention will be presented as 312mg capsules. The participant will start by taking two capsules (approximately 625mg) three times a day for three days, and if there are no side effects will then increase to four capsules (1.25g) three times a day. Side effects will be monitored by use of a daily patient diary and telephone interviews on days one and three. Patients will Primary outcome(s): Low Anterior Resection Syndrome (LARS) Score, from a validated questionnaire. This questionnaire will be administered in Dunedin Hospital by a research assistant before and after each treatment. [LARS score will be measured prior to commencement of the first treatment, at the end of the first 5-week treatment phase, prior to commencement of the second treatment (approximately 11 weeks post-enrollment), and at the end of the second 5-week treatment phase.];Short-form 12 Health Survey, a quality of life questionnaire. This questionnaire will be administered in Dunedin Hospital by a research assistant before and after each treatment. [Quality of life will be measured prior to commencement of the first treatment, at the end of the first 5-week treatment phase, prior to commencement of the second treatment (approximately 11 weeks post-enrollment), and at the end of the second 5-week treatment phase.];Faecal Incontinence Quality of Life Score. This will be administered at Dunedin Hospital by a research assistant.[Quality of life will be measured prior to commencement of the first treatment, at the end of the first 5-week treatment phase, prior to commencement of the second treatment (approximately 11 weeks post-enrollment), and at the end of the second 5-week treatment phase.] Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Crossover;Type of endpoint: Safety/efficacy

Project description:Interventions: Pelvic floor muscle training will be delivered via 6 fortnightly, 1 hour, face to face one on one physiotherapy appointments over 12 weeks (at least 4 weeks before and at least 6 weeks after ileostomy closure following low anterior resection) using a standardised approach to each appointment to deliver an individualised treatment plan for each patient. Each session will consist of a targeted history to determine symptoms, education about lifestyle modifications, assessment of Pelvic floor muscles via anal palpation with/ or Transabdominal ultrasound (where available), education and review of exercises. Patients will then be asked to perform exercises daily for 3 times per day and this will be logged in an exercise diary. The exercises and emphasis will be tailored to a patient’s symptoms and ability. An example of the exercises prescribed in would be as follows: These exercises are a set prescription of repetitions Initially, muscle identification exercises - Position: Sitting forward in a chair, with knees and legs apart - Exercise: Squeeze pelvic floor and identify pelvic floor lift Rest 4 seconds, then repeat 3-4 times This will be repeated 3 times/day Then, an ongoing regime of this exercise will be prescribed as follows: Exercise 1- Hold 5-10sec, rest5-10sec ( pending on patient’s ability)/5reps increase to 10 reps/3xday Exercise 2- Hold/Rest/ 10reps increase to 20 reps/3xday Follow exercise 3, 4 and daily application as above The duration of these exercises is variable as this depends on the repetitions rather than a specific time. Primary outcome(s): Incidence of low anterior resection syndrome via validated Low Anterior Resection Score (LARS) developed and validated by Emmertson et al in 2012 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 May;255(5):922-8. doi: 10.1097/SLA.0b013e31824f1c21. PMID: 22504191.[1, 6 and 12 months after closure of loop ileostomy] Study Design: Purpose: Prevention; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

Project description:IntroductionRectal cancer affects more than 600 patients per year in Wales, with a 5-year survival rate of around 60%. A recent report demonstrated that 19% of patients with bowel cancer had difficulty controlling their bowels after surgery, and these patients were twice as likely to report lower quality of life than those who had control. Nearly all patients will experience bowel dysfunction initially following surgery and up to 25% will experience severe bowel dysfunction on a long-term basis. The aim of this study is to test the feasibility of introducing a simple intervention in an attempt to improve bowel function following surgery for rectal cancer. We propose the introduction of an educational session from specialist nurses and physiotherapists prior to surgery and a subsequent physiotherapy programme for 3 months to teach patients how to strengthen their pelvic floor.Methods and analysisAll patients with rectal cancer planned to receive an anterior resection will be approached for the study. The study will take place in three centres over 12 months, and we expect to recruit 40 patients. The primary outcome measure is the proportion of eligible patients approached who consent to and attend the educational session. The secondary outcomes include patient compliance to the pelvic floor rehabilitation programme (assessed by patient paper or electronic diary), the acceptability of the intervention to the patient (assessed using qualitative interviews) and preoperative and postoperative pelvic floor tone (assessed using the Oxford Grading System and the International Continence Society Grading System), patient bowel function and patient quality of life (assessed using validated questionnaires).Ethics and disseminationEthics approval was granted. This feasibility study is in progress. If patients find the intervention acceptable, the next stage would be a trial comparing outcomes after anterior resection in those who have and do not have physiotherapy.Trial registration numberISRCTN77383505; Pre-results.

Dataset Information

Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life.

Publications

Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure