Evaluation and treatment progress of postoperative low anterior resection syndrome for rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Wei ^1,2 , GUAN Haidi ² , QIU Yuan ² , YANG Hua ² ,  XIAO Weidong ²

1. No. 3 Group, Basic Medical College of Air Force Military Medical University, Xi’an 710068, P. R. China;
2. Department of General Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, P. R. China;

Corresponding?author：

XIAO Weidong, Email: weidong.xiao@126.com

Keywords：

rectal cancer; anterior low resection syndrome; assessment; treatment

DOI：

10.7507/1007-9424.201907005

Video：

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Objective To understand the current evaluation methods and treatment progress of low anterior resection syndrome (LARS) after rectal cancer surgery.Method The recent literatures on the progress of LARS studies were reviewed.Results The occurrence mechanism of LARS was closely related to the function state of anus before operation, the nerve and muscle injuries around the anus and rectum during the operation, as well as the new rectal volume and compliance. For this symptom group, there were various clinical evaluation methods, including the various quality of life score scales, fecal incontinence related scales, LARS score scale, anorectal pressure measurement, and imaging examination of anal sphincter, etc. The treatment included the anal lavage, comprehensive rehabilitation training, sacral nerve stimulation, traditional Chinese medicine therapy, and other treatment methods.Conclusion LARS might be prevented or alleviated through accurately preoperative evaluation, standardized and reasonable surgery and adjuvant therapy, and effective postoperative intervention.

Citation： JIANG Wei, GUAN Haidi, QIU Yuan, YANG Hua, XIAO Weidong. Evaluation and treatment progress of postoperative low anterior resection syndrome for rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 624-628. doi: 10.7507/1007-9424.201907005 Copy

1.	Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics. CA Cancer J Clin, 2016, 66(4): 271-289.
2.	Bryant CL, Lunniss PJ, Knowles CH, et al. Anterior resection syndrome. Lancet Oncol, 2012, 13(9): e403-e408.
3.	Croese AD, Zubair ON, Lonie J, et al. Prevalence of low anterior resection syndrome at a regional Australian centre. ANZ J Surg, 2018, 88(12): E813-E817.
4.	劉凡, 郭鵬, 申占龍, 等. 低位前切除綜合征相關危險因素分析. 中華胃腸外科雜志, 2017, 20(3): 289-294.
5.	師博, 唐勁, 田利軍, 等. 直腸癌患者發生低位前切除綜合征的相關危險因素. 中國現代醫學雜志, 2019, 29(12): 93-96.
6.	Contin P, Kulu Y, Bruckner T, et al. Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int J Colorectal Dis, 2014, 29(2): 165-175.
7.	Lange MM, Martz JE, Ramdeen B, et al. Long-term results of rectal cancer surgery with a systematical operative approach. Ann Surg Oncol, 2013, 20(6): 1806-1815.
8.	Wells CI, Vather R, Chu MJ, et al. Anterior resection syndrome—a risk factor analysis. J Gastrointest Surg, 2015, 19(2): 350-359.
9.	蒲羽, 邱遠, 李祥, 等. 直腸癌保肛術后低位前切除綜合征發生率、恢復情況及影響因素的回顧性分析. 第三軍醫大學學報, 2017, 39(10): 1025-1030.
10.	艾旭, 馬旭, 龍舟, 等. 不同腸道重建術對直腸癌患者肛門功能的影響. 臨床和實驗醫學雜志, 2016, 15(15): 1482-1485.
11.	劉曉波, 童衛東. 直腸前切除綜合征的研究進展. 中華結直腸疾病電子雜志, 2015, 4(2): 166-169.
12.	Ihn MH, Kang SB, Kim DW, et al. Risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery: a prospective study using the Memorial Sloan Kettering Cancer Center bowel function instrument. Dis Colon Rectum, 2014, 57(8): 958-966.
13.	Lange MM, den Dulk M, Bossema ER, et al. Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg, 2007, 94(10): 1278-1284.
14.	Juul T, Ahlberg M, Biondo S, et al. Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum, 2014, 57(5): 585-591.
15.	Alavi K, Chan S, Wise P, et al. Fecal incontinence: etiology, diagnosis, and management. J Gastrointest Surg, 2015, 19(10): 1910-1921.
16.	周昱. 直腸粘膜5-羥色胺表達水平與直腸癌前切除患者生活質量及前切除綜合征發病的關系. 河北醫學, 2016, 22(10): 1676-1679.
17.	Temple LK, Bacik J, Savatta SG, et a1. The development of avalidated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum, 2005, 48(7): 1353-1365.
18.	Hou XT, Pang D, Lu Q, et al. Bowel dysfunction and self-management for bowel symptoms after sphincter-preserving surgery: A cross-sectional survey of Chinese rectal cancer patients. Cancer Nurs, 2017, 40(4): E9-E16.
19.	顧盡暉, 史仁杰. 低位直腸癌前切除術后患者生命質量的評價. 實用臨床醫藥雜志, 2011, 15(23): 175-178.
20.	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(5): 922-928.
21.	曹蘭玉, 魏力, 王春梅. 直腸癌前切除綜合征評分量表的漢化及信效度評價. 中國實用護理雜志, 2013, 29(27): 69-72.
22.	閆晶晶, 牟紹玉, 譚人福, 等. 直腸癌低位前切除綜合征評分表中文版的實證研究. 解放軍護理雜志, 2015, 32(4): 12-15.
23.	孫雅亭, 馬師洋, 董蕾. 測壓技術在胃腸道中的應用進展. 胃腸病學, 2018, 23(8): 502-505.
24.	Jimenez-Gomez LM, Espin-Basany E, Trenti L, et al. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis, 2017 Sep 29. doi: 10.1111/codi.13901.
25.	朱文峰, 方建強, 崔蕾, 等. 直腸腔內超聲評估大便失禁患者肛管括約肌缺損的臨床價值. 結直腸肛門外科, 2017, 23(3): 379-382.
26.	Bharucha AE, Rao SS. An update on anorectal disorders for gastroenterologists. Gastroenterology, 2014, 146(1): 37-45.
27.	顧晉, 潘宏達. 直腸前切除綜合征的防范與處理. 中華胃腸外科雜志, 2016, 19(4): 366-369.
28.	Kupsch J, Jackisch T, Matzel KE, et al. Outcome of bowel function following anterior resection for rectal cancer—an analysis using the low anterior resection syndrome (LARS) score. Int J Colorectal Dis, 2018, 33(6): 787-798.
29.	Iwama T, Imajo M, Yaegashi K, et al. Self washout method for defecational complaints following low anterior rectal resection. Jpn J Surg, 1989, 19(2): 251-253.
30.	Rosen H, Robert-Yap J, Tentschert G, et al. Transanal irrigation improves quality of life in patients with low anterior resection syndrome. Colorectal Dis, 2011, 13(10): e335-e338.
31.	Visser WS, Te Riele WW, Boerma D, et al. Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Ann Coloproctol, 2014, 30(3): 109-114.
32.	陳洪亮, 王奇, 章利, 等. 生物反饋治療直腸癌低位前切除綜合征療效觀察. 中國肛腸病雜志, 2016, 36(6): 10-12.
33.	Lundby L, Duelund-Jakobsen J. Management of fecal incontinence after treatment for rectal cancer. Curr Opin Support Palliat Care, 2011, 5(1): 60-64.
34.	Chebil O, Behr M, Arnoux PJ. Quasi-static failure properties of the human gastro-colic ligament. Comput Methods Biomech Biomed Engin, 2012, 15(Suppl 1): 283-284.
35.	LaCross A, Groff M, Smaldone A. Obstetric anal sphincter injury and anal incontinence following vaginal birth: a systematic review and meta-analysis. J Midwifery Womens Health, 2015, 60(1): 37-47.
36.	Tan E, Ngo NT, DarziA, et a1. Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence. Int J Colorectal Dis, 2011, 26(3): 275-294.
37.	Schwandner O. Sacral neuromodulation for fecal incontinence and "low anterior resection syndrome" following neoadjuvant therapy for rectal cancer. Int J Colorectal Dis, 2013, 28(5): 665-669.
38.	彭桂平, 何桂秀, 王爾榮. 針刺治療泄瀉110例. 陜西中醫, 2006, 27(1): 89-90.
39.	桂林, 劉云肖, 郭伶俐, 等. 針灸治療中低位直腸癌前切除術后綜合征. 遼寧中醫雜志, 2010, 37(8): 1579-1580.
40.	Hotouras A, Thaha MA, Boyle DJ, et al. Short-term outcome following percutaneous tibial nerve stimulation for faecal incontinence: a single-centre prospective study. Colorectal Dis, 2012, 14(9): 1101-1105.
41.	Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev, 2013, (2): CD007959.
42.	Pathi SD, Acevedo JF, Keller PW, et al. Recovery of the injured external anal sphincter after injection of local or intravenous mesenchymal stem cells. Obstet Gynecol, 2012, 119(1): 134-144.

1. Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics. CA Cancer J Clin, 2016, 66(4): 271-289.
2. Bryant CL, Lunniss PJ, Knowles CH, et al. Anterior resection syndrome. Lancet Oncol, 2012, 13(9): e403-e408.
3. Croese AD, Zubair ON, Lonie J, et al. Prevalence of low anterior resection syndrome at a regional Australian centre. ANZ J Surg, 2018, 88(12): E813-E817.
4. 劉凡, 郭鵬, 申占龍, 等. 低位前切除綜合征相關危險因素分析. 中華胃腸外科雜志, 2017, 20(3): 289-294.
5. 師博, 唐勁, 田利軍, 等. 直腸癌患者發生低位前切除綜合征的相關危險因素. 中國現代醫學雜志, 2019, 29(12): 93-96.
6. Contin P, Kulu Y, Bruckner T, et al. Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int J Colorectal Dis, 2014, 29(2): 165-175.
7. Lange MM, Martz JE, Ramdeen B, et al. Long-term results of rectal cancer surgery with a systematical operative approach. Ann Surg Oncol, 2013, 20(6): 1806-1815.
8. Wells CI, Vather R, Chu MJ, et al. Anterior resection syndrome—a risk factor analysis. J Gastrointest Surg, 2015, 19(2): 350-359.
9. 蒲羽, 邱遠, 李祥, 等. 直腸癌保肛術后低位前切除綜合征發生率、恢復情況及影響因素的回顧性分析. 第三軍醫大學學報, 2017, 39(10): 1025-1030.
10. 艾旭, 馬旭, 龍舟, 等. 不同腸道重建術對直腸癌患者肛門功能的影響. 臨床和實驗醫學雜志, 2016, 15(15): 1482-1485.
11. 劉曉波, 童衛東. 直腸前切除綜合征的研究進展. 中華結直腸疾病電子雜志, 2015, 4(2): 166-169.
12. Ihn MH, Kang SB, Kim DW, et al. Risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery: a prospective study using the Memorial Sloan Kettering Cancer Center bowel function instrument. Dis Colon Rectum, 2014, 57(8): 958-966.
13. Lange MM, den Dulk M, Bossema ER, et al. Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg, 2007, 94(10): 1278-1284.
14. Juul T, Ahlberg M, Biondo S, et al. Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum, 2014, 57(5): 585-591.
15. Alavi K, Chan S, Wise P, et al. Fecal incontinence: etiology, diagnosis, and management. J Gastrointest Surg, 2015, 19(10): 1910-1921.
16. 周昱. 直腸粘膜5-羥色胺表達水平與直腸癌前切除患者生活質量及前切除綜合征發病的關系. 河北醫學, 2016, 22(10): 1676-1679.
17. Temple LK, Bacik J, Savatta SG, et a1. The development of avalidated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum, 2005, 48(7): 1353-1365.
18. Hou XT, Pang D, Lu Q, et al. Bowel dysfunction and self-management for bowel symptoms after sphincter-preserving surgery: A cross-sectional survey of Chinese rectal cancer patients. Cancer Nurs, 2017, 40(4): E9-E16.
19. 顧盡暉, 史仁杰. 低位直腸癌前切除術后患者生命質量的評價. 實用臨床醫藥雜志, 2011, 15(23): 175-178.
20. 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(5): 922-928.
21. 曹蘭玉, 魏力, 王春梅. 直腸癌前切除綜合征評分量表的漢化及信效度評價. 中國實用護理雜志, 2013, 29(27): 69-72.
22. 閆晶晶, 牟紹玉, 譚人福, 等. 直腸癌低位前切除綜合征評分表中文版的實證研究. 解放軍護理雜志, 2015, 32(4): 12-15.
23. 孫雅亭, 馬師洋, 董蕾. 測壓技術在胃腸道中的應用進展. 胃腸病學, 2018, 23(8): 502-505.
24. Jimenez-Gomez LM, Espin-Basany E, Trenti L, et al. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis, 2017 Sep 29. doi: 10.1111/codi.13901.
25. 朱文峰, 方建強, 崔蕾, 等. 直腸腔內超聲評估大便失禁患者肛管括約肌缺損的臨床價值. 結直腸肛門外科, 2017, 23(3): 379-382.
26. Bharucha AE, Rao SS. An update on anorectal disorders for gastroenterologists. Gastroenterology, 2014, 146(1): 37-45.
27. 顧晉, 潘宏達. 直腸前切除綜合征的防范與處理. 中華胃腸外科雜志, 2016, 19(4): 366-369.
28. Kupsch J, Jackisch T, Matzel KE, et al. Outcome of bowel function following anterior resection for rectal cancer—an analysis using the low anterior resection syndrome (LARS) score. Int J Colorectal Dis, 2018, 33(6): 787-798.
29. Iwama T, Imajo M, Yaegashi K, et al. Self washout method for defecational complaints following low anterior rectal resection. Jpn J Surg, 1989, 19(2): 251-253.
30. Rosen H, Robert-Yap J, Tentschert G, et al. Transanal irrigation improves quality of life in patients with low anterior resection syndrome. Colorectal Dis, 2011, 13(10): e335-e338.
31. Visser WS, Te Riele WW, Boerma D, et al. Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Ann Coloproctol, 2014, 30(3): 109-114.
32. 陳洪亮, 王奇, 章利, 等. 生物反饋治療直腸癌低位前切除綜合征療效觀察. 中國肛腸病雜志, 2016, 36(6): 10-12.
33. Lundby L, Duelund-Jakobsen J. Management of fecal incontinence after treatment for rectal cancer. Curr Opin Support Palliat Care, 2011, 5(1): 60-64.
34. Chebil O, Behr M, Arnoux PJ. Quasi-static failure properties of the human gastro-colic ligament. Comput Methods Biomech Biomed Engin, 2012, 15(Suppl 1): 283-284.
35. LaCross A, Groff M, Smaldone A. Obstetric anal sphincter injury and anal incontinence following vaginal birth: a systematic review and meta-analysis. J Midwifery Womens Health, 2015, 60(1): 37-47.
36. Tan E, Ngo NT, DarziA, et a1. Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence. Int J Colorectal Dis, 2011, 26(3): 275-294.
37. Schwandner O. Sacral neuromodulation for fecal incontinence and "low anterior resection syndrome" following neoadjuvant therapy for rectal cancer. Int J Colorectal Dis, 2013, 28(5): 665-669.
38. 彭桂平, 何桂秀, 王爾榮. 針刺治療泄瀉110例. 陜西中醫, 2006, 27(1): 89-90.
39. 桂林, 劉云肖, 郭伶俐, 等. 針灸治療中低位直腸癌前切除術后綜合征. 遼寧中醫雜志, 2010, 37(8): 1579-1580.
40. Hotouras A, Thaha MA, Boyle DJ, et al. Short-term outcome following percutaneous tibial nerve stimulation for faecal incontinence: a single-centre prospective study. Colorectal Dis, 2012, 14(9): 1101-1105.
41. Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev, 2013, (2): CD007959.
42. Pathi SD, Acevedo JF, Keller PW, et al. Recovery of the injured external anal sphincter after injection of local or intravenous mesenchymal stem cells. Obstet Gynecol, 2012, 119(1): 134-144.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Evaluation and treatment progress of postoperative low anterior resection syndrome for rectal cancer

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