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MRI measurements predict major low anterior resection syndrome in rectal cancer patients

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Current low anterior resection syndrome (LARS) score is lagging behind and only based on clinical symptoms patient described. Preoperative imaging indicators which can be used to predict LARS is unknown. We proposed preoperative MRI parameters for identifying major LARS.

Methods

Patients receiving curative restorative anterior resection from Sept. 2007 to Sept. 2015 were collected to complete LARS score (median 75.7 months since surgery). MRI measurements associated with LARS were tested, and a multivariate logistic model was conducted for predicting LARS. Receiver operating characteristic curve was used to evaluate the model.

Results

Two hundred fifty-five patients undergoing neoadjuvant chemoradiotherapy and 72 patients undergoing direct surgery were enrolled. The incidence of major LARS in NCRT group was significantly higher (53.3% vs.34.7%, P = 0.005). In patients with neoadjuvant chemoradiotherapy, the thickness of ARJ (TARJ), the distance between the tumor’s lower edge and anal rectal joint (DTA), and sex were independent factors for predicting major LARS; ORs were 0.382 (95% CI, 0.198–0.740), 0.653 (95% CI, 0.565–0.756), and 0.935 (95% CI, 0.915–0.955). The AUC of the multivariable model was 0.842 (95% CI, 0.794–0.890). In patients with direct surgery, only DTA was the independent factor for predicting major LARS; OR was 0.958 (95% CI, 0.930–0.988). The AUC was 0.777 (95% CI: 0.630–0.925).

Conclusions

Baseline MRI measurements have the potential to predict major LARS in rectal cancer, which will benefit the decision-making and improve patients’ life quality.

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References

  1. Emmertsen KJ, Laurberg S (2013) Rectal Cancer Function Study Group. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 100:1377–1387

  2. Bryant CL, Lunniss PJ, Knowles CH et al (2012) Anterior resection syndrome. Lancet Oncol 13:e403-408

    Article  Google Scholar 

  3. Engel J, Kerr J, Schlesinger-Raab A et al (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238:203–213

    PubMed  PubMed Central  Google Scholar 

  4. Taylor C, Bradshaw E (2013) Tied to the toilet: lived experiences of altered bowel function (anterior resection syndrome) after temporary stoma reversal. J Wound Ostomy Continence Nurs 40:415–421

    Article  Google Scholar 

  5. Croese AD, Lonie JM, Trollope AF, Vangaveti VN, Ho YH (2018) A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors. Int J Surg 56:234–241. https://doi.org/10.1016/j.ijsu.2018.06.031. (Epub 2018 Jun 22 PMID: 29936195)

    Article  PubMed  Google Scholar 

  6. Sun R, Dai Z, Zhang Y, Lu J, Zhang Y, Xiao Y (2021) The incidence and risk factors of low anterior resection syndrome (LARS) after sphincter-preserving surgery of rectal cancer: a systematic review and meta-analysis. Support Care Cancer 29(12):7249–7258. https://doi.org/10.1007/s00520-021-06326-2. (Epub 2021 Jul 23 PMID: 34296335)

    Article  PubMed  Google Scholar 

  7. Emmertsen KJ, Laurberg S (2012) 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 255(5):922–928

    Article  Google Scholar 

  8. Sarcher T, Dupont B, Alves A et al (2018) Anterior resection syndrome: What should we tell practitioners and patients in 2018? J Visc Surg 155(5):383–391

    Article  CAS  Google Scholar 

  9. Battersby NJ, Bouliotis G, Emmertsen KJ et al (2018) Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score. Gut 67(4):688–696. https://doi.org/10.1136/gutjnl-2016-312695. (Epub 2017 Jan 23 PMID: 28115491)

    Article  PubMed  Google Scholar 

  10. Juul T, Ahlberg M, Biondo S et al (2014) International validation of the low anterior resection syndrome score. Ann Surg 259(4):728–734

    Article  Google Scholar 

  11. Wang L, Li ZY, Li ZW et al (2015) Efficacy and safety of neoadjuvant intensity-modulated radiotherapy with concurrent capecitabine for locally advanced rectal cancer. Dis Colon Rectum 58:186–192

    Article  Google Scholar 

  12. Balachandran VP, Gonen M, Smith JJ et al (2015) Nomograms in oncology: more than meets the eye. Lancet Oncol 16:E173-180

    Article  Google Scholar 

  13. Scheer AS, Boushey RP, Liang S et al (2011) The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 54(12):1589–1597

    Article  Google Scholar 

  14. Pucciani F (2013) A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. Updates Surg 65(4):257–263

    Article  Google Scholar 

  15. Bharucha AE, Fletcher JG, Harper CM et al (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic fecal incontinence. Gut 54:546–555

    Article  CAS  Google Scholar 

  16. Terra MP, Beets-Tan RGH, Vervoorn I et al (2008) Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence. Eur Radiol 18:1892–1901

    Article  Google Scholar 

  17. Lewicky-Gaupp C, Brincat C, Yousuf A et al (2010) Fecal incontinence in older women: are levator ani defects a factor? Am J Obstet Gynecol 202(491):e491-496

    Google Scholar 

  18. Grimes WR, Stratton M (2022) Pelvic Floor Dysfunction. 2021 Jul 1. In: StatPearls. Treasure Island (FL): StatPearls Publishing. PMID: 32644672

  19. Lottrup C, Gregersen H, Liao D et al (2015) Functional lumen imaging of the gastrointestinal tract. J Gastroenterol 50(10):1005–1016. https://doi.org/10.1007/s00535-015-1087-7. (Epub 2015 May 16 PMID: 25980822)

    Article  PubMed  Google Scholar 

  20. How P, Evans J, Moran B et al (2012) Preoperative MRI sphincter morphology and anal manometry: can they be markers of functional outcome following anterior resection for rectal cancer? Colorectal Dis 14:e339–e345

    Article  CAS  Google Scholar 

  21. Marijnen CA, van de Velde CJ, Putter H et al (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23(9):1847–1858

    Article  Google Scholar 

  22. Allgayer H, Dietrich CF, Rohde W et al (2005) Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol 40(10):1168–1175

    Article  Google Scholar 

  23. Lange MM, den Dulk M, Bossema ER et al (2007) Cooperative clinical investigators of the dutch total mesorectal excision trial. Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg 94(10):1278–1284.

  24. Stephens RJ, Thompson LC, Quirke P et al (2010) Impact of short course preoperative radiotherapy for rectal cancer on patients’ quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J Clin Oncol 28(27):4233–4239

    Article  Google Scholar 

  25. Engin G (2006) Cervical cancer: MR imaging findings before, during, and after radiation therapy. Eur Radiol 16(2):313–324

    Article  Google Scholar 

  26. Chi P, Chen Z, Gao Y et al (2015) Diagnosis and treatment of pelvic wall and bowel fibrosis with bowel obstruction induced by neoadjuvant chemoradiotherapy for rectal carcinoma. Zhonghua Wei Chang Wai Ke Za Zhi 18(11):1092–1097. (Chinese)

    PubMed  Google Scholar 

  27. Sauer R, Becker H, Hohenberger W et al (2004) German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740.

  28. Bondeven P, Emmertsen KJ, Laurberg S et al (2015) Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery. Eur J Surg Oncol 41(11):1493–1499. https://doi.org/10.1016/j.ejso.2015.07.003. (Epub 2015 Jul 15 PMID: 26219852)

    Article  CAS  PubMed  Google Scholar 

  29. Haak HE, Maas M, Lambregts DMJ et al (2020) Is watch and wait a safe and effective way to treat rectal cancer in older patients? Eur J Surg Oncol 46(3):358–362. https://doi.org/10.1016/j.ejso.2020.01.005. (Epub 2020 Jan 8 PMID: 31982206)

    Article  PubMed  Google Scholar 

  30. Pieniowski EHA, Palmer GJ, Juul T et al (2019) Low Anterior Resection Syndrome and Quality of Life After Sphincter-Sparing Rectal Cancer Surgery: A Long-term Longitudinal Follow-up. Dis Colon Rectum 62(1):14–20. https://doi.org/10.1097/DCR.0000000000001228. (PMID: 30394987)

    Article  PubMed  Google Scholar 

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Author notes

  1. Xiao-Yan Zhang and Xin-Zhi Liu contributed equally to this work.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Beijing, 100142, Hai Dian District, China

    Xiao-Yan Zhang, Xiao-Ting Li, Hai-Bin Zhu, Rui-Jia Sun, Zhen Guan, Qiao-Yuan Lu, Hai-Tao Zhu & Ying-Shi Sun

  2. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Beijing, 100142, Hai Dian District, China

    Xin-Zhi Liu, Lin Wang & Ai-Wen Wu

  3. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, 100142, Hai Dian District, China

    Wei-Hu Wang

  4. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, 100142, Hai Dian District, China

    Zhong-Wu Li

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  1. Xiao-Yan Zhang
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Contributions

Xiao-Yan Zhang, Liu Xin-Zhi, Ying-Shi Sun, and Ai-Wen Wu designed the study; Xiao-Yan Zhang, Xin-Zhi Liu, Lin Wang, Hai-Bin Zhu, Rui-Jia Sun, Zhen Guan, Qiao-Yuan Lu, Wei-Hu Wang, and Zhong-Wu Li collected data; Xiao-Yan Zhang, Xin-Zhi Liu, Xiao-Ting Li, Hai-Tao Zhu, Ying-Shi Sun, and Ai-Wen Wu analyzed and interpreted the data; Xiao-Yan Zhang and Xin-Zhi Liu drafted the manuscript; all authors reviewed and approved the manuscript.

Corresponding authors

Correspondence to Ai-Wen Wu or Ying-Shi Sun.

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The authors declare no competing interests.

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Highlights

• Low anterior resection syndrome (LARS) score is lagging behind, while there are no recognized preoperative indicators for predicting LARS. This study identified preoperative MRI feature for predicting LARS and developed a MR-based model.

• The distance between the lower edge of the tumor and anorectal joint (DTA) was proved an independent factor for predicting major low anterior resection syndrome (LARS) in both neoadjuvant therapy group and direct surgery group. In neoadjuvant therapy group, the thickness of the anal rectal joint (TARJ) was also an independent factor for predicting major LARS.

• Multivariate models were constructed for predicting major LARS; AUC were 0.842 and 0.777 for neoadjuvant therapy group and direct surgery group, respectively.

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Cite this article

Zhang, XY., Liu, XZ., Li, XT. et al. MRI measurements predict major low anterior resection syndrome in rectal cancer patients. Int J Colorectal Dis 37, 1239–1249 (2022). https://doi.org/10.1007/s00384-022-04169-9

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