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.	刘凡, 郭鹏, 申占龙, 等. 低位前切除综合征相关危险因素分析. 中华胃肠外科杂志, 2017, 20(3): 289-294.
5.	师博, 唐劲, 田利军, 等. 直肠癌患者发生低位前切除综合征的相关危险因素. 中国现代医学杂志, 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, 邱远, 李祥, 等. 直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析. 第三军医大学学报, 2017, 39(10): 1025-1030.
10.	艾旭, 马旭, 龙舟, 等. 不同肠道重建术对直肠癌患者肛门功能的影响. 临床和实验医学杂志, 2016, 15(15): 1482-1485.
11.	刘晓波, 童卫东. 直肠前切除综合征的研究进展. 中华结直肠疾病电子杂志, 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. 直肠粘膜5-羟色胺表达水平与直肠癌前切除患者生活质量及前切除综合征发病的关系. 河北医学, 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.	顾尽晖, 史仁杰. 低位直肠癌前切除术后患者生命质量的评价. 实用临床医药杂志, 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.	曹兰玉, 魏力, 王春梅. 直肠癌前切除综合征评分量表的汉化及信效度评价. 中国实用护理杂志, 2013, 29(27): 69-72.
22.	闫晶晶, 牟绍玉, 谭人福, 等. 直肠癌低位前切除综合征评分表中文版的实证研究. 解放军护理杂志, 2015, 32(4): 12-15.
23.	孙雅亭, 马师洋, 董蕾. 测压技术在胃肠道中的应用进展. 胃肠病学, 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, 方建强, 崔蕾, 等. 直肠腔内超声评估大便失禁患者肛管括约肌缺损的临床价值. 结直肠肛门外科, 2017, 23(3): 379-382.
26.	Bharucha AE, Rao SS. An update on anorectal disorders for gastroenterologists. Gastroenterology, 2014, 146(1): 37-45.
27.	顾晋, 潘宏达. 直肠前切除综合征的防范与处理. 中华胃肠外科杂志, 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.	陈洪亮, 王奇, 章利, 等. 生物反馈治疗直肠癌低位前切除综合征疗效观察. 中国肛肠病杂志, 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, 王尔荣. 针刺治疗泄泻110例. 陕西中医, 2006, 27(1): 89-90.
39.	桂林, 刘云肖, 郭伶俐, 等. 针灸治疗中低位直肠癌前切除术后综合征. 辽宁中医杂志, 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. 刘凡, 郭鹏, 申占龙, 等. 低位前切除综合征相关危险因素分析. 中华胃肠外科杂志, 2017, 20(3): 289-294.
5. 师博, 唐劲, 田利军, 等. 直肠癌患者发生低位前切除综合征的相关危险因素. 中国现代医学杂志, 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, 邱远, 李祥, 等. 直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析. 第三军医大学学报, 2017, 39(10): 1025-1030.
10. 艾旭, 马旭, 龙舟, 等. 不同肠道重建术对直肠癌患者肛门功能的影响. 临床和实验医学杂志, 2016, 15(15): 1482-1485.
11. 刘晓波, 童卫东. 直肠前切除综合征的研究进展. 中华结直肠疾病电子杂志, 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. 直肠粘膜5-羟色胺表达水平与直肠癌前切除患者生活质量及前切除综合征发病的关系. 河北医学, 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. 顾尽晖, 史仁杰. 低位直肠癌前切除术后患者生命质量的评价. 实用临床医药杂志, 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. 曹兰玉, 魏力, 王春梅. 直肠癌前切除综合征评分量表的汉化及信效度评价. 中国实用护理杂志, 2013, 29(27): 69-72.
22. 闫晶晶, 牟绍玉, 谭人福, 等. 直肠癌低位前切除综合征评分表中文版的实证研究. 解放军护理杂志, 2015, 32(4): 12-15.
23. 孙雅亭, 马师洋, 董蕾. 测压技术在胃肠道中的应用进展. 胃肠病学, 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, 方建强, 崔蕾, 等. 直肠腔内超声评估大便失禁患者肛管括约肌缺损的临床价值. 结直肠肛门外科, 2017, 23(3): 379-382.
26. Bharucha AE, Rao SS. An update on anorectal disorders for gastroenterologists. Gastroenterology, 2014, 146(1): 37-45.
27. 顾晋, 潘宏达. 直肠前切除综合征的防范与处理. 中华胃肠外科杂志, 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. 陈洪亮, 王奇, 章利, 等. 生物反馈治疗直肠癌低位前切除综合征疗效观察. 中国肛肠病杂志, 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, 王尔荣. 针刺治疗泄泻110例. 陕西中医, 2006, 27(1): 89-90.
39. 桂林, 刘云肖, 郭伶俐, 等. 针灸治疗中低位直肠癌前切除术后综合征. 辽宁中医杂志, 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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