Assessment of low anterior resection syndrome in patients who underwent low anterior resection for cancer rectum

摘要

Background and aim : Rectal Cancer is the third most common form of cancer and the second leading cause of cancer related deaths in the western world. It occurs due to abnormal growth of the lining cells of the rectum that have the ability to invade and spread to other parts of the body. Surgery is the only curative therapy for rectal cancer. Transabdominal surgery can be performed with either sphincter sparing techniques i.e. (anterior resection) or an abdominal perineal resection. Historically, abdominal perineal resection was the gold standard for treating low-lying rectal cancers. With the advent of better surgical techniques and equipments e.g. (staplers) as well as neo-adjuvant therapy abdominal perineal resection has been gradually replaced by sphincter sparing procedures. For patients in whom negative distal margin can be achieved sphincter sparing procedures are preferred because they maintain bowel continence and avoid a permanent colostomy. However, functional disturbances constitute a major problem for many surviving rectal cancer patients following a sphincter saving procedure with symptoms ranging from daily episodes of incontinence to obstructed defecation, constipation & low anterior resection syndrome (LARS). LARS is used to describe a variety of symptoms: bowel, urinary and sexual dysfunction. The bowel dysfunction may be categorized into storage dysfunction (which includes bowel frequency, Fecal urgency and incontinence).And the evacuatory dysfunction (which includes stool fragmentation, gas stool discrimination, tenesmus and anal pain). Low anterior resection is common and has been reported in 10% to 90% of post-rectal resection patients. Aim of the work: We assessed the low anterior resection syndrome in patients with rectal cancer who underwent low anterior resection as regards incidence, timing & its fate or improvement. Methods: This was a retrospective observational study included 52 patients with low rectal cancer who underwent low anterior resection at Tanta Cancer Center (TCC) and Ain Shams University Hospital between (January 2015 - January 2017). Each patient will fill four questionnaires to cover the following periods after restoration of their bowel continuity (1 month, 6 month, 1year and 2 years) . Results: The overall incidence of LARS in our study varied from 88.5% at one month point to decline to 79.1% at 24 months point also there was a decrease in the percentage of patients with major LARS and increase in the percentage of patients with minor or no LARS across the different follow-up time points. However, this notable change in LARS status across time points was not statistically significant. The average overall LARS score showed a gradual and statistically significant decrease over the 24-month follow-up period (from 30.92 to 27.04). The major decline occurred from the 6-month to the 12-month scores. Conclusion: Rectal surgeries contributed to increase of survival rates of rectal cancer patients. Yet bowel dysfunction may result thus affects the quality of life of rectal cancer survivors. LARS is an important consequence that affects a large number of rectal cancer survivors. However, it is reported that the severity of LARS decreases with time for these patients. Therefore, it is important that clinicians and researchers focus on LARS and conduct further studies to determine its contributing factors and improve the prevention and treatment strategies.