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International Journal of Colorectal Disease

, Volume 31, Issue 4, pp 813–823 | Cite as

Low anterior resection syndrome: a survey of the members of the American Society of Colon and Rectal Surgeons (ASCRS), the Spanish Association of Surgeons (AEC), and the Spanish Society of Coloproctology (AECP)

  • Luis Miguel Jimenez-GomezEmail author
  • Eloy Espin-Basany
  • Marc Marti-Gallostra
  • Jose Luis Sanchez-Garcia
  • Francesc Vallribera-Valls
  • Manuel Armengol-Carrasco
Original Article

Abstract

Background

Low anterior resection syndrome (LARS) is frequent following sphincter-sparing procedures for rectal cancer.

Objective

This study aims to assess surgeons’ awareness of LARS.

Design

This was a survey study.

Settings

Members of the American Society of Colon and Rectal Surgeons (ASCRS), the Spanish Association of Surgeons (AEC), and the Spanish Society of Coloproctology (AECP).

Participants

Three hundred thirty-four surgeons from the ASCRS and 150 from the Spanish Societies completed a 23-item electronic questionnaire.

Main outcome measures

Surgeons’ opinions regarding different aspects of LARS.

Results

The proportion of rectal cancer patients undergoing sphincter-sparing operations ranged between 71 and 90 %. Low anterior resection with end-to-end anastomosis was the most frequently cited procedure after mesorectal excision. More than 80 % of participants were recognized to be moderately or extremely aware of the condition, but regarding the method used to assess LARS, the majority relied on clinical manifestations. Around 35 % of surgeons considered that severe LARS developed in less than 40 % of patients. The most important factor related to defecatory function impairment in the surgeons’ opinion was the distance from the anal margin to anastomosis. Other factors thought to be involved were anastomotic leakage, preoperative radiation therapy, age, and postoperative radiotherapy, with similar percentages in the two groups of surgeons. Lifestyle changes and dietary measures associated with or without drug treatment was the modality of choice. The experience with transanal irrigation or sacral nerve stimulation was limited. It was considered that <30 % of patients chronically suffer from severe LARS with significant quality of life impairment.

Limitations

The limitations of this study are the international mix and expert status of the specialists.

Conclusions

The probability of patients suffering from LARS was underestimated despite reporting good knowledge of the syndrome. Validated methods for the assessment of LARS were rarely used. Deficient awareness regarding risk factors for LARS was documented. Knowledge of therapeutic options was also limited.

Keywords

Low anterior resection syndrome Rectal cancer Low anterior resection Surgeon’s opinion Survey study 

Notes

Acknowledgments

The authors thank Marta Pulido, MD, for editing the manuscript and editorial assistance.

Contribution of each author

L.M. Jimenez-Gomez: conception and design of the study, development of the survey questionnaire, implementation of the web-based platforms, analysis and interpretation of results, writing of the manuscript, and approval the final draft.

E. Espin-Basany: conception and design of the study, collection of data, analysis and interpretation of results, revision of the initial draft for intellectual content, and approval the final draft.

M. Marti-Gallostra: analysis of results, revision of the manuscript, and approval of the final draft.

J.L. Sanchez-Garcia: analysis of results, revision of the manuscript, and approval of the final draft.

F. Vallribera-Valls: analysis of results, revision of the manuscript, and approval of the final draft.

M. Armengol-Carrasco: supervision and coordination of the study, analysis and interpretation of results, and approval of the final draft.

Compliance with ethical standards

Conflicts of interest

None of the authors has any conflict of interest to be declared.

References

  1. 1.
    Gaertner WB, Kwaan MR, Madoff RD, Melton GB (2015) Rectal cancer: an evidence-based update for primary care providers. World J Gastroenterol 21:7659–7671CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Steele SR, Chang GJ, Hendren S et al (2015) Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. Dis Colon Rectum 58:713–725CrossRefPubMedGoogle Scholar
  3. 3.
    Harji DP, Griffiths B, Velikova G, Sagar PM, Brown J (2015) Systematic review of health-related quality of life issues in locally recurrent rectal cancer. J Surg Oncol 111:431–438CrossRefPubMedGoogle Scholar
  4. 4.
    Thaysen HV, Jess P, Laurberg S (2012) Health-related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer: a review. Color Dis 14:797–803CrossRefGoogle Scholar
  5. 5.
    Walma MS, Kornmann VN, Boerma D, de Roos MA, van Westreenen HL (2015) Predictors of fecal incontinence and related quality of life after a total mesorectal excision with primary anastomosis for patients with rectal cancer. Ann Coloproctol 31:23–28CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ziv Y, Zbar A, Bar-Shavit Y, Igov I (2013) Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations. Tech Coloproctol 17:151–162CrossRefPubMedGoogle Scholar
  7. 7.
    Bregendahl S, Emmertsen KJ, Lous J, Laurberg S (2013) Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Color Dis 15:1130–1139Google Scholar
  8. 8.
    Emmertsen KJ, Laurberg S, Rectal Cancer Function Study Group (2013) Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 100:1377–1387CrossRefPubMedGoogle Scholar
  9. 9.
    Chen TY, Emmertsen KJ, Laurberg S (2014) Bowel dysfunction after rectal cancer treatment: a study comparing the specialist’s versus patient’s perspective. BMJ Open 4:e003374. doi: 10.1136/bmjopen-2013-003374 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Oliphant R, Nicholson GA, Horgan PG et al (2013) Contribution of surgical specialization to improved colorectal cancer survival. Br J Surg 100:1388–1395CrossRefPubMedGoogle Scholar
  11. 11.
    Oliphant R, Nicholson GA, Horgan PG et al (2014) The impact of surgical specialisation on survival following elective colon cancer surgery. Int J Color Dis 29:1143–1150CrossRefGoogle Scholar
  12. 12.
    Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH (2012 Mar 14) Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev 3, CD005391Google Scholar
  13. 13.
    Tilney HS, Heriot AG, Purkayastha S et al (2008) A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg 247:77–84CrossRefPubMedGoogle Scholar
  14. 14.
    Marwan K, Staples MP, Thursfield V, Bell SW (2010) The rate of abdominoperineal resections for rectal cancer in the state of Victoria, Australia: a population-based study. Dis Colon Rectum 53:1645–1651CrossRefPubMedGoogle Scholar
  15. 15.
    Engel AF, Oomen JL, Eijsbouts QA, Cuesta MA, van de Velde CJ (2003) Nationwide decline in annual numbers of abdomino-perineal resections: effect of a successful national trial? Color Cancer Dis 5:180–184CrossRefGoogle Scholar
  16. 16.
    Juul T, Ahlberg M, Biondo S, Emmertsen KJ, Espin E, Jimenez LM et al (2014) International validation of the low anterior resection syndrome score. Ann Surg 259:728–734CrossRefPubMedGoogle Scholar
  17. 17.
    Juul T, Battersby NJ, Christensen P et al (2015) Validation of the English translation of the low anterior resection syndrome score. Color Dis 17:908–916CrossRefGoogle Scholar
  18. 18.
    Wells CI, Vather R, Chu MJ, Robertson JP, Bissett IP (2015) Anterior resection syndrome—a risk factor analysis. J Gastrointest Surg 19:350–359CrossRefPubMedGoogle Scholar
  19. 19.
    Ashburn JH, Stocchi L, Kiran RP, Dietz DW, Remzi FH (2013) Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life. Dis Colon Rectum 56:275–280CrossRefPubMedGoogle Scholar
  20. 20.
    Bittorf B, Stadelmaier U, Merkel S, Hohenberger W, Matzel KE (2003) Does anastomotic leakage affect functional outcome after rectal resection for cancer? Langenbecks Arch Surg 387:406–410PubMedGoogle Scholar
  21. 21.
    Loos M, Quentmeier P, Schuster T et al (2013) Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients: a systematic review and meta-analysis. Ann Oncol 20:1816–1828CrossRefGoogle Scholar
  22. 22.
    Lorenzi B, Brading AF, Martellucci J, Cetta F, Mortensen NJ (2012) Short-term effects of neoadjuvant chemoradiotherapy on internal anal sphincter function: a human in vitro study. Dis Colon Rectum 55:465–472CrossRefPubMedGoogle Scholar
  23. 23.
    Hüttner FJ, Tenckhoff S, Jensen K et al (2015) Meta-analysis of reconstruction techniques after low anterior resection for rectal cancer. Br J Surg 102:735–745CrossRefPubMedGoogle Scholar
  24. 24.
    Lindgren R, Hallböök O, Rutegård J, Sjödahl R, Matthiessen P (2011) Does a defunctioning stoma affect anorectal function after low rectal resection? Results of a randomized multicenter trial. Dis Colon Rectum 54:747–752CrossRefPubMedGoogle Scholar
  25. 25.
    Tan WS, Tang CL, Shi L, Eu KW (2009) Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 96:462–472CrossRefPubMedGoogle Scholar
  26. 26.
    Kim KH, Yu CS, Yoon YS, Yoon SN, Lim SB, Kim JC (2011) Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery. Dis Colon Rectum 54:1107–1113CrossRefPubMedGoogle Scholar
  27. 27.
    Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y (2012) Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Color Dis 14:1231–1237CrossRefGoogle Scholar
  28. 28.
    Visser WS, Te Riele WW, Boerma D, van Ramshorst B, van Westreenen HL (2014) Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Ann Coloproctol 30:109–114CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Rosen H, Robert-Yap J, Tentschert G, Lechner M, Roche B (2011) Transanal irrigation improves quality of life in patients with low anterior resection syndrome. Color Dis 13:e335–e338CrossRefGoogle Scholar
  30. 30.
    Christensen P, Krogh K (2010) Transanal irrigation for disordered defecation: a systematic review. Scand J Gastroenterol 45:517–527CrossRefPubMedGoogle Scholar
  31. 31.
    Ramage L, Qiu S, Kontovounisios C, Tekkis P, Rasheed S, Tan E (2015) A systematic review of sacral nerve stimulation for low anterior resection syndrome. Color Dis 17:762.771CrossRefGoogle Scholar
  32. 32.
    de Miguel M, Oteiza F, Ciga MA, Armendáriz P, Marzo J, Ortiz H (2011) Sacral nerve stimulation for the treatment of faecal incontinence following low anterior resection for rectal cancer. Color Dis 13:72–77CrossRefGoogle Scholar
  33. 33.
    Schwandner O (2013) Sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer. Int J Color Dis 28:665–669CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Luis Miguel Jimenez-Gomez
    • 1
    Email author
  • Eloy Espin-Basany
    • 1
  • Marc Marti-Gallostra
    • 1
  • Jose Luis Sanchez-Garcia
    • 1
  • Francesc Vallribera-Valls
    • 1
  • Manuel Armengol-Carrasco
    • 1
  1. 1.Colorectal Unit, Department of General SurgeryHospital Universitari Vall d’Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain

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