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Sun V, Guthrie KA, Crane TE, Arnold KB, Colby S, Freylersythe SG, Braun-Inglis C, Topacio R, Messick CA, Carmichael JC, Muskovitz AA, Nashawaty M, Bajaj M, Cohen SA, Flaherty DC, O’Rourke MA, Jones L, Krouse RS, Thomson CA. SWOG S1820: A pilot randomized trial of the Altering Intake, Managing Bowel Symptoms Intervention in Survivors of Rectal Cancer. Cancer 2024; 130:2384-2394. [PMID: 38386696 PMCID: PMC11162313 DOI: 10.1002/cncr.35264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Survivors of rectal cancer experience persistent bowel dysfunction after treatments. Dietary interventions may be an effective approach for symptom management and posttreatment diet quality. SWOG S1820 was a pilot randomized trial of the Altering Intake, Managing Symptoms in Rectal Cancer (AIMS-RC) intervention for bowel dysfunction in survivors of rectal cancer. METHODS Ninety-three posttreatment survivors were randomized to the AIMS-RC group (N = 47) or the Healthy Living Education attention control group (N = 46) after informed consent and completion of a prerandomization run-in. Outcome measures were completed at baseline and at 18 and 26 weeks postrandomization. The primary end point was total bowel function score, and exploratory end points included low anterior resection syndrome (LARS) score, quality of life, dietary quality, motivation, self-efficacy, and positive/negative affect. RESULTS Most participants were White and college educated, with a mean age of 55.2 years and median time since surgery of 13.1 months. There were no statistically significant differences in total bowel function score by group, with the AIMS-RC group demonstrating statistically significant improvements in the exploratory end points of LARS (p = .01) and the frequency subscale of the bowel function index (p = .03). The AIMS-RC group reported significantly higher acceptability of the study. CONCLUSIONS SWOG S1820 did not provide evidence of benefit from the AIMS-RC intervention relative to the attention control. Select secondary end points did demonstrate improvements. The study was highly feasible and acceptable for participants in the National Cancer Institute Community Oncology Research Program. Findings provide strong support for further refinement and effectiveness testing of the AIMS-RC intervention.
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Affiliation(s)
- Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, CA
- Department of Surgery, City of Hope, Duarte, CA
| | - Katherine A. Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Tracy E. Crane
- Divsion of Medical Oncology, Miller School of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Kathryn B. Arnold
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Sarah Colby
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA
| | - Sarah G. Freylersythe
- Divsion of Medical Oncology, Miller School of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | | | | | | | | | | | - Mohammed Nashawaty
- Minnesota Oncology (Metro Minnesota Community Oncology Research Consortium), Edina, MN
| | - Madhuri Bajaj
- Illinois Cancer Care (Heartland Cancer Research NCORP), Peoria, IL
| | | | - Devin C. Flaherty
- Valley Health Surgical Oncology (VCU Massey Cancer Center Minority Underserved NCORP), Winchester, VA
| | - Mark A. O’Rourke
- Prisma Health Cancer Institute (NCORP of the Carolinas Prisma Health NCORP), Greenville, SC
| | | | - Robert S. Krouse
- Perelman School of Medicine, University of Pennsylvania and the Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Cynthia A. Thomson
- University of Arizona Cancer Center, Tucson, AZ
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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Chiang T, Hsu Y, Chern Y, Liao C, Tsai W, Hsieh P, Hsu H, Lin Y, Lee H, You J. Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery. Cancer Med 2024; 13:e7022. [PMID: 38400678 PMCID: PMC10891461 DOI: 10.1002/cam4.7022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/21/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE Low anterior resection syndrome (LARS) has had many impacts on the lives of patients and substantial differences in emotional and social functions. The aim of this study was to investigate the correlation analysis of different personality traits in rectal cancer patients with LARS after undergoing curative surgery. METHODS This study was designed as a prospective cohort study. The inclusion criteria included (1) participants diagnosed with rectal cancer who underwent surgical resection of malignant tumors and (2) ECOG 0-1. The primary outcome was the correlation between different personality traits and low anterior resection syndrome in rectal cancer patients after radical surgery. Low anterior resection syndrome incidence rates were estimated by questionnaires and personality groups by the Type A and Type D Scale-14 Personality Inventory. RESULTS For all 161 participants in this study, the presence of a tumor at the lower anal verge and the receipt of neoadjuvant CCRT had a statistically significant positive correlation with the LARS score at 1 month, 6 months, and 1 year (Pearson correlation coefficient = -0.283, -0.374, and - 0.205, respectively), with a p value of less than 0.05. Personalities with Type A, Type D, and Type D-SI scores had a statistically significant positive correlation with LARS score at 1 month (Pearson correlation coefficient = 0.172, 0.162, and 0,164, p value = 0.03, 0.04, and 0.04). CONCLUSION Type A and Type D personalities are highly linked to LARS. Personalized support approaches can ultimately assist rectal cancer patients in overcoming difficulties after surgery and recovery and enhance their functional outcomes.
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Affiliation(s)
- Ting‐Yu Chiang
- Department of Nursing, Chang Gung Medical FoundationLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Yu‐Jen Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Yih‐Jong Chern
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Chun‐Kai Liao
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Wen‐Sy Tsai
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Pao‐Shiu Hsieh
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Hung‐Chih Hsu
- Division of Hematology‐Oncology, Chang Gung Memorial Hospital at Linkou, College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Yu‐Fen Lin
- Department of Nursing, Chang Gung Medical FoundationLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Hsiu‐Lan Lee
- Department of Nursing, Chang Gung Medical FoundationLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Jeng‐Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of MedicineChang Gung UniversityTaoyuanTaiwan
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Langenfeld SJ, Davis BR, Vogel JD, Davids JS, Temple LKF, Cologne KG, Hendren S, Hunt S, Garcia Aguilar J, Feingold DL, Lightner AL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement. Dis Colon Rectum 2024; 67:18-31. [PMID: 37647138 DOI: 10.1097/dcr.0000000000003057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Jon D Vogel
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Larissa K F Temple
- Colorectal Surgery Division, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Kyle G Cologne
- Department of Surgery, Division of Colorectal Surgery, University of Southern California, Los Angeles, California
| | - Samantha Hendren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Steven Hunt
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Julio Garcia Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel L Feingold
- Department of Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L Lightner
- Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ian M Paquette
- Department of Surgery, Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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4
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Chan H, Savoie MB, Munir A, Moslehi J, Anwar M, Laffan A, Rowen T, Salmon R, Varma M, Van Loon K. Multi-Disciplinary Management in Rectal Cancer Survivorship: A Clinical Practice Review. J Gastrointest Cancer 2023; 54:1102-1115. [PMID: 36622517 PMCID: PMC10754749 DOI: 10.1007/s12029-022-00885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/10/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer in the USA and worldwide. In the USA, nearly one-third of CRC cases are anatomically classified as rectal cancer. Over the past few decades, continued refinement of multimodality treatment and the introduction of new therapeutic agents have enhanced curative treatment rates and quality of life outcomes. As treatments improve and the incidence of young onset rectal cancer rises, the number of rectal cancer survivors grows each year. This trend highlights the growing importance of rectal cancer survivorship. Multimodality therapy with systemic chemotherapy, chemoradiation, and surgery can result in chronic toxicities in multiple organ systems, requiring a multi-disciplinary care model with services ranging from appropriate cancer surveillance to management of long-term toxicities and optimization of modifiable risk factors. Here, we review the evidence on these long-term toxicities and provide management considerations from consensus guidelines. Specific topics include bowel dysfunction from radiation and surgery, oxaliplatin-induced neuropathy, accelerated bone degeneration, the impact of fluoropyrimidines on long-term cardiovascular health, urinary incontinence, sexual dysfunction, and psychosocial distress. Additionally, we review modifiable risk factors to inform providers and rectal cancer survivors of various lifestyle and behavioral changes that can be made to improve their long-term health outcomes.
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Affiliation(s)
- Hilary Chan
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco (UCSF), 550 16th Street, Floor 06, Room 6803, Box 3211, San Francisco, CA, 94158, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Marissa B Savoie
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Amir Munir
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, UCSF, San Francisco, CA, USA
| | - Javid Moslehi
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, UCSF, San Francisco, CA, USA
| | - Mekhail Anwar
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Radiation Oncology, UCSF, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Angela Laffan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Tami Rowen
- Department of Obstetrics and Gynecology, UCSF, San Francisco, CA, USA
| | - Rebeca Salmon
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Madhulika Varma
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Section of Colorectal Surgery, Department of Surgery, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Katherine Van Loon
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco (UCSF), 550 16th Street, Floor 06, Room 6803, Box 3211, San Francisco, CA, 94158, USA.
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
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Liapis SC, Baloyiannis I, Perivoliotis K, Lytras D, Theodoropoulos G, Tzovaras G. The Role of Percutaneous Tibial Nerve Stimulation (PTNS) in Low Anterior Resection Syndrome (LARS): A Systematic Review and Meta-analysis. J Gastrointest Cancer 2023; 54:1128-1139. [PMID: 36703030 DOI: 10.1007/s12029-023-00910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim of the present study was to evaluate the pooled efficacy of percutaneous tibial nerve stimulation (PTNS) in patients with low anterior resection syndrome (LARS). MATERIAL AND METHODS This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The primary endpoint was the pooled effect size of PTNS in LARS score (LARSS). Secondary endpoints included incontinence (Fecal Incontinence Score-FIC, Obstructive Defecation Syndrome-ODS), sexual functionality and quality of life (QoL) questionnaires, and manometric evaluations. Continuous outcomes were reported as weighted mean difference (WMD), with the corresponding 95% confidence interval (95% CI). Quality evaluation was performed via the National Institutes of Health (NIH) quality assessment tool. RESULTS Overall, 5 studies were included. PTNS resulted to reduced LARSS values (WMD: - 5.68, 95%CI: - 7.73, - 3.63, p < 0.001). A similar effect was noted in St Mark's FIC (p < 0.001) and ODS (p = 0.02) score. An improvement in several QoL scales was found. There was no effect in sexual functionality and manometric measurements. Compared to sham, PTNS significantly improved LARSS. CONCLUSIONS The application of PTNS in patients with LARS results in an improvement in multiple clinical parameters, including defecation functionality and quality of life. Due to several study limitations, further high quality RCTs are required to delineate the exact efficacy of PTNS.
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Affiliation(s)
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | | | - Dimitrios Lytras
- Department of Surgery, General Hospital of Volos, Polymeri 134, 38222, Volos, Greece
| | - Georgios Theodoropoulos
- Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Georgios Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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Ore AS, Vigna C, Arean-Sanz R, Quinn JF, Crowell K, Fabrizio A, Messaris E. Beyond the Expected Postoperative Period: Are We Underdiagnosing Low Anterior Resection Syndrome? J Gastrointest Surg 2023; 27:2586-2588. [PMID: 37468734 DOI: 10.1007/s11605-023-05767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Ana Sofia Ore
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Carolina Vigna
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Rodrigo Arean-Sanz
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jeanne F Quinn
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Kristen Crowell
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Anne Fabrizio
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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7
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Zhang R, Luo W, Qiu Y, Chen F, Luo D, Yang Y, He W, Li Q, Li X. Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment. Cancers (Basel) 2023; 15:5011. [PMID: 37894378 PMCID: PMC10605930 DOI: 10.3390/cancers15205011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Low anterior resection syndrome (LARS) is a series of bowel dysfunction symptoms, including altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation. LARS occurs in 80% of patients undergoing sphincter-preserving surgery, affecting patients' quality of life along with social avoidance. Different measurements and treatments have been raised to deal with LARS, but no systematic standard has been developed. OBJECTIVE AND METHODS To promote the standardization of clinical trials and clinical management of LARS, this review summarizes the latest findings up until 2023 regarding the diagnostic criteria, assessment protocols, and treatment modalities for postoperative LARS in rectal cancer. RESULTS The diagnostic criteria for LARS need to be updated to the definition proposed by the LARS International Collaborative Group, replacing the current application of the LARS score. In both clinical trials and clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire, the LARS score or MSKCC BFI, and at least one scale related to quality of life. Anorectal manometry, fecoflowmetry, endoscopic ultrasonography, and pelvic floor muscle strength testing are recommended to be adopted only in clinical trials. After analysis of the latest literature on LARS treatment, a stepwise classification model is established for the standardized clinical management of LARS. Patients with minor LARS can start with first-line treatment, including management of self-behavior with an emphasis on diet modification and medication. Lamosetron, colesevelam hydrochloride, and loperamide are common antidiarrheal agents. Second-line management indicates multi-mode pelvic floor rehabilitation and transanal irrigation. Patients with major LARS should select single or several treatments in second-line management. Refractory LARS can choose antegrade enema, neuromodulation, or colostomy. CONCLUSIONS In clinical trials of LARS treatment between 2020 and 2022, the eligibility criteria and evaluation system have been variable. Therefore, it is urgent to create a standard for the diagnosis, assessment, and treatment of LARS. Failure to set placebos and differentiate subgroups are limitations of many current LARS studies. Randomized controlled trials comparing diverse therapies and long-term outcomes are absent, as well. Moreover, a new scale needs to be developed to incorporate the patient's perspective and facilitate outpatient follow-up. Though the establishment of a stepwise classification model for LARS treatment here is indispensable, the refinement of the guidelines may be improved by more standardized studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Qingguo Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; (R.Z.); (W.L.); (Y.Q.); (F.C.); (D.L.); (Y.Y.); (W.H.)
| | - Xinxiang Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; (R.Z.); (W.L.); (Y.Q.); (F.C.); (D.L.); (Y.Y.); (W.H.)
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8
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Deen R, Ediriweera DS, Thillakaratne S, Hewavissenthi J, Kumarage SK, Chandrasinghe PC. Neoadjuvant Chemoradiation for Rectal Cancer Achieves Satisfactory Tumour Regression and Local Recurrence - Result of a Dedicated Multi-disciplinary Approach from a South Asian Centre. BMC Cancer 2023; 23:400. [PMID: 37142979 PMCID: PMC10158249 DOI: 10.1186/s12885-023-10769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/25/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Pre-operative long-course chemoradiotherapy (CRT) for rectal cancer has resulted in improvement in rates of restorative rectal resection and local recurrence by inducing tumour downstaging and downsizing. Total mesorectal excision (TME) is a standardised surgical technique of low anterior resection aimed at the prevention of local tumour recurrence. The purpose of this study was to evaluate tumour response following CRT in a standardised group of patients with rectal cancer. METHODS One hundred and thirty-one patients (79 male; 52 female, median age 57; interquartile range 47-62 years) of 153 with rectal cancer who underwent pre-operative long-course CRT were treated by standardised open low anterior resection at a median of 10 weeks post-CRT. Sixteen of 131 (12%) were 70 years or older. Median follow-up at the time of analysis was 15 months (interquartile range 6-45 months). Pathology reports were analysed based on AJCC-UICC classification using the TNM system. Data recorded were overall/subgrades of tumour regression; good, moderate or poor, lymph node harvest, local recurrence, disease-free and overall survival using standard statistical methods. RESULTS 78% showed tumour regression post-CRT; 43% displayed good tumour regression/response while 22% had poor tumour regression/response. All patients had a pre-operative T-stage of either T3 or T4. Post-operation, good responders had a median T stage of T2 vs. T3 in poor responders (P = 0.0002). Overall, the median lymph node harvest was < 12. There was no difference in the number of nodes harvested in good vs. poor responders (Good/moderate-6 nodes vs. Poor- 8; P = 0.31). Good responders tended to have a lesser number of malignant nodes vs. poor responders (P = 0.31). Overall, local recurrence was 6.8% and the anal sphincter preservation rate was 89%. Predicted 5-year disease-free and overall survival were similar between good and poor responders. CONCLUSION Long-course CRT resulted in satisfactory tumour regression and enabled consideration for safe, sphincter-saving resection in rectal cancer. A dedicated multi-disciplinary team approach achieved a global benchmark for local recurrence in a resource-limited setting.
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Affiliation(s)
- Raeed Deen
- Department of Surgery, Wollongong Hospital, Wollongong, NSW, Australia.
| | - Dileepa S Ediriweera
- Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Janaki Hewavissenthi
- Department of Pathology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Sumudu K Kumarage
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Pramodh C Chandrasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
- The Department of Surgery, University of Kelaniya and North Colombo Teaching Hospital, Ragama, Sri Lanka
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„Low anterior resection syndrome“ (LARS) in Zahlen. COLOPROCTOLOGY 2023. [DOI: 10.1007/s00053-022-00674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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10
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Burch J, Wright J, Taylor C, Wilson A, Norton C. 'He's a surgeon, like I'm not going to waste his time': interviews to determine healthcare needs of people with low anterior resection syndrome after rectal cancer surgery. Colorectal Dis 2023; 25:880-887. [PMID: 36633117 DOI: 10.1111/codi.16475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/19/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
AIM The aim of this study was to determine the views of people on their healthcare needs when managing their bowel symptoms following an anterior resection. METHOD One-to-one, semi-structured interviews were undertaken, after consent and completion of three questionnaires. Results were analysed using a modified framework analysis and presented narratively. RESULTS Twenty three participants aged 38-75 years were interviewed; 10 were men. Most had low anterior resection syndrome (LARS) scores indicating 'major LARS', Bowel Function Index scores ranged from 28 to 65. The two most bothersome symptoms were faecal incontinence and unpredictable bowel function. Data were grouped into three broad themes: 'treatment consequences', 'strategies and compromises' and 'healthcare needs.' Each theme had four subthemes, such as 'bowel dysfunction' in the theme 'treatment consequences'. Bowel symptoms were common and persistent. Symptom management often required multiple interventions. Expressed healthcare needs included managing expectations through clinician-led information. Participants needed knowledgeable clinicians to enquire about and assess symptoms, provide and reiterate information as well as making an onward referral to enable symptom management. Peers improved the adaptation process through support and advice. Our findings indicate that participants' needs are not being fully met. CONCLUSION People with LARS have unmet healthcare requirements needed to meet their individual goals. We propose these are addressed by using the acronym 'LARS': a Learned clinician who Asks and assesses bowel symptoms, Revisiting the topic to address new or persisting symptoms as well as Signposting, advising or referring onwards as needed.
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Affiliation(s)
- Jennie Burch
- St Mark's the National Bowel Hospital, London, UK
| | | | - Claire Taylor
- Department of Surgery, London North West University Healthcare NHS Trust, London, UK
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Departments of Surgery and Cancer, Imperial College London, London, UK.,Department of Surgery, St Mark's Hospital, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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