The Low Anterior Resection Syndrome Score after The Intersphincteric Resection for Low Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 MAMing-xing ,  CONGJin-chun , CHENChun-sheng , XIAZhi-xiu

Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding author：

CONGJin-chun, Email: congjinchun@sj-hospital.org

Keywords：

Low anterior resection syndrome score; Intersphincteric resection; Low anterior resection

DOI：

10.7507/1007-9424.20160315

Video：

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Objective The low anterior resection syndrome (LARS) score is a simple and visual instrument assessing sphincter preserving surgery for low rectal cancer. The purpose of this study is to analyze the feasibility of using LARS score to assess the function after intersphincteric resection for low rectal cancer. Methods Between March 2013 and June 2015, 76 patients underwent sphincter preserving surgery for low rectal cancer, 23 cases underwent intersphincteric resection set as ISR group, the other 53 cases received low anterior resection set as LAR group. LARS score, Saito function questionnaire, Wexner score, and European organization for research and treatment of cancer (EORTC) quality of life questionnaire core 30 (QLQ-C30), questionnaire module for colorectal cancer (QLQ-CR29) were compared for the two groups. Results There were 63.2 percent patients (48/76) appeared major LARS, 27.6 percent (21/76) minor LARS and 9.2 percent (7/76) no LARS, there were no statistically difference between the ISR and LAR groups (P=0.727), but the item of incontinence due to liquid stools appeared more obvious in ISR group (P=0.009). The items of faecel incontinence and sore skin for EORTC QLQ-CR29 were serious in ISR group (P < 0.05), the other item of EORTC QLQ-CR29 and EORTC QLQ-C30, Saito function questionnaire, Wexner score were similar between the two groups (all P > 0.05). Conclusion The anal function after intersphincteric resection is non-inferior to the low anterior resection for low rectal cancer, but both can appear serious low anterior resection syndrome.

Citation： MA Ming-xing, CONG Jin-chun, CHEN Chun-sheng, XIA Zhi-xiu. The Low Anterior Resection Syndrome Score after The Intersphincteric Resection for Low Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(10): 1225-1230. doi: 10.7507/1007-9424.20160315 Copy

1.	Kyzer S, Gordon PH. Experience with the use of the circular stapler in rectal surgery. Dis Colon Rectum, 1992, 35(7):696-706.
2.	Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal cancer tumors. Br J Surg, 1994, 81(9):1376-1378.
3.	Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg, 2012, 99(5):603-612.
4.	Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum, 2013, 56(5):535-550.
5.	Pachler J, Wille-Jorgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev, 2005, 18(2):CD004323.
6.	Aaronson NK,Ahmedzai S,Bergman B,et al. The European Organization for Research and Treatment of Cancer QLQ-C30:a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5):365-376.
7.	Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer, 1999, 35(2):238-247.
8.	Gujral S, Conroy T, Fleissner C, et al. European Organization for Research and Treatment of Cancer Quality of Life Group. Assessing quality of life in patients with colorectal cancer:an update of the EORTC quality of life questionnaire. Eur J Cancer, 2007, 43(10):1564-1573.
9.	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.
10.	Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer:an active approach to avoid a permanent colostomy. Dis Colon Rectum, 2004, 47(4):459-466.
11.	Jore JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1):77-97.
12.	Cong JC, Chen CS, Ma MX, et al. Laparoscopic intersphincteric resection for low rectal cancer:comparison of stapled and manual coloanal anastomosis. Colorectal Dis, 2014, 16(5):353-358.
13.	Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum:a proposal by the International Study Group of Rectal Cancer. Surgery, 2010, 147(3):339-351.
14.	丛进春, 戴显伟, 张宏, 等. 低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究. 中国普外基础与临床杂志, 2007, 14(6):634-638.
15.	丛进春, 戴显伟, 张宏, 等. 超低位直肠癌经括约肌间切除术后的肛门功能评价. 中国现代医学杂志,2008, 18(6):795-798.
16.	池畔, 林惠铭, 卢星榕, 等. 腹腔镜经盆腔入路括约肌间超低位直肠前切除术治疗直肠癌可行性研究. 中国实用外科杂志, 2010, 30(3):203-205.
17.	Emmertsen KJ, Laurberg S; Rectal Cancer Function Study Group. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg, 2013, 100(10):1377-1387.
18.	Hou XT, Pang D, Lu Q, et al. Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients. Eur J Oncol Nurs, 2015, 19(5):495-501.
19.	Chen TY, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short course radiotherapy and total mesorectal excision for rectal cancer:report of a multicenter randomized trial. Clin Colorectal Cancer, 2015, 14(2):106-114.
20.	Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, et al. Factors determining low anterior resection syndrome after rectal cancer resection:a study in Thai patients. Asian J Surg, 2015, pii:S1015-9584(15) 00086-X.
21.	Luca F, Valvo M, Guerra-Cogorno M, et al. Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis. Eur J Surg Oncol. 2016, 42(6):841-847.
22.	Samalavicius NE, Dulskas A, Lasinskas M, et al. Validity and reliability of a Lithuanian version of low anterior resection syndrome score. Tech Coloproctol. 2016, 20(4):215-220.
23.	Carrillo A, Enríquez-Navascués JM, Rodríguez A, et al. Incidence and characterization of the anterior resection syndrome through the use of the LARS scale (low anterior resection score). Cir Esp, 2016, 94(3):137-143.
24.	Beppu N, Kimura H, Matsubara N, et al. Long-term functional outcomes of total mesorectal excision following chemoradiotherapy for lower rectal cancer:stapled anastomosis versus intersphincteric resection. Dig Surg, 2016, 33(1):33-42.
25.	丛进春, 陈春生, 马明星, 等. 新辅助治疗对局部进展期直肠癌患者的生活质量的影响.中国普通外科杂志, 2014, 23(4):451-457.

1. Kyzer S, Gordon PH. Experience with the use of the circular stapler in rectal surgery. Dis Colon Rectum, 1992, 35(7):696-706.
2. Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal cancer tumors. Br J Surg, 1994, 81(9):1376-1378.
3. Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg, 2012, 99(5):603-612.
4. Monson JR, Weiser MR, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum, 2013, 56(5):535-550.
5. Pachler J, Wille-Jorgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev, 2005, 18(2):CD004323.
6. Aaronson NK,Ahmedzai S,Bergman B,et al. The European Organization for Research and Treatment of Cancer QLQ-C30:a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993, 85(5):365-376.
7. Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer, 1999, 35(2):238-247.
8. Gujral S, Conroy T, Fleissner C, et al. European Organization for Research and Treatment of Cancer Quality of Life Group. Assessing quality of life in patients with colorectal cancer:an update of the EORTC quality of life questionnaire. Eur J Cancer, 2007, 43(10):1564-1573.
9. 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.
10. Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer:an active approach to avoid a permanent colostomy. Dis Colon Rectum, 2004, 47(4):459-466.
11. Jore JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1):77-97.
12. Cong JC, Chen CS, Ma MX, et al. Laparoscopic intersphincteric resection for low rectal cancer:comparison of stapled and manual coloanal anastomosis. Colorectal Dis, 2014, 16(5):353-358.
13. Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum:a proposal by the International Study Group of Rectal Cancer. Surgery, 2010, 147(3):339-351.
14. 丛进春, 戴显伟, 张宏, 等. 低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究. 中国普外基础与临床杂志, 2007, 14(6):634-638.
15. 丛进春, 戴显伟, 张宏, 等. 超低位直肠癌经括约肌间切除术后的肛门功能评价. 中国现代医学杂志,2008, 18(6):795-798.
16. 池畔, 林惠铭, 卢星榕, 等. 腹腔镜经盆腔入路括约肌间超低位直肠前切除术治疗直肠癌可行性研究. 中国实用外科杂志, 2010, 30(3):203-205.
17. Emmertsen KJ, Laurberg S; Rectal Cancer Function Study Group. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg, 2013, 100(10):1377-1387.
18. Hou XT, Pang D, Lu Q, et al. Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients. Eur J Oncol Nurs, 2015, 19(5):495-501.
19. Chen TY, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short course radiotherapy and total mesorectal excision for rectal cancer:report of a multicenter randomized trial. Clin Colorectal Cancer, 2015, 14(2):106-114.
20. Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, et al. Factors determining low anterior resection syndrome after rectal cancer resection:a study in Thai patients. Asian J Surg, 2015, pii:S1015-9584(15) 00086-X.
21. Luca F, Valvo M, Guerra-Cogorno M, et al. Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis. Eur J Surg Oncol. 2016, 42(6):841-847.
22. Samalavicius NE, Dulskas A, Lasinskas M, et al. Validity and reliability of a Lithuanian version of low anterior resection syndrome score. Tech Coloproctol. 2016, 20(4):215-220.
23. Carrillo A, Enríquez-Navascués JM, Rodríguez A, et al. Incidence and characterization of the anterior resection syndrome through the use of the LARS scale (low anterior resection score). Cir Esp, 2016, 94(3):137-143.
24. Beppu N, Kimura H, Matsubara N, et al. Long-term functional outcomes of total mesorectal excision following chemoradiotherapy for lower rectal cancer:stapled anastomosis versus intersphincteric resection. Dig Surg, 2016, 33(1):33-42.
25. 丛进春, 陈春生, 马明星, 等. 新辅助治疗对局部进展期直肠癌患者的生活质量的影响.中国普通外科杂志, 2014, 23(4):451-457.

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The Low Anterior Resection Syndrome Score after The Intersphincteric Resection for Low Rectal Cancer

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