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Vol. 34. Issue 1.
Pages 55-61 (January - April 2014)
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Vol. 34. Issue 1.
Pages 55-61 (January - April 2014)
Review article
DOI: 10.1016/j.jcol.2014.02.004
Open Access
Functional results after treatment for rectal cancer
Resultados funcionais após tratamento de câncer retal
Visits
...
Katrine Jossing Emmertsen
Corresponding author
katrineemmertsen@dadlnet.dk

Corresponding author.
, Tina Yen-Ting Chen, Soren Laurberg
Colorectal Research Unit, Colorectal Surgical Department P, Aarhus University Hospital, Aarhus, Denmark
Article information
Abstract
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Abstract
Introduction

With improving survival of rectal cancer, functional outcome has become in- creasingly important. Following sphincter-preserving resection many patients suffer from severe bowel dysfunction with an impact on quality of life (QoL) – referred to as low ante- rior resection syndrome (LARS).

Study objective

To provide an overview of the current knowledge of LARS regarding symp- tomatology, occurrence, risk factors, pathophysiology, evaluation instruments and treat- ment options.

Results

LARS is characterized by urgency, frequent bowel movements, emptying difficulties and incontinence, and occurs in up to 50-75% of patients on a long-term basis. Known risk factors are low anastomosis, use of radiotherapy, direct nerve injury and straight anasto- mosis. The pathophysiology seems to be multifactorial, with elements of anatomical, sen- sory and motility dysfunction. Use of validated instruments for evaluation of LARS is es- sential. Currently, there is a lack of evidence for treatment of LARS. Yet, transanal irrigation and sacral nerve stimulation are promising.

Conclusion

LARS is a common problem following sphincter-preserving resection. All pa- tients should be informed about the risk of LARS before surgery, and routinely be screened for LARS postoperatively. Patients with severe LARS should be offered treatment in order to improve QoL. Future focus should be on the possibilities of non-resectional treatment in order to prevent LARS.

Keywords:
Rectal cancer LARS Bowel dysfunction Functional outcome Quality of life
Resumo
Introdução

Com o aumento da sobrevida após câncer retal, o resultado funcional se tornou cada vez mais importante. Após ressecção com preservação do esfíncter, muitos pacientes sofrem de disfunção intestinal com um impacto sobre a qualidade de vida (QdV) – denomi- nada síndrome da ressecção anterior baixa (LARS).

Objetivo do estudo

Fornecer uma visão geral do conhecimento atual da LARS com relação à sintomatologia, à ocorrência, aos fatores de risco, à fisiopatologia, aos instrumentos de avaliação e às opções de tratamento.

Resultados

A LARS é caracterizada por movimentos intestinais repentinos e frequentes, di- ficuldades de esvaziamento e incontinência e ocorre em até 50-75% dos pacientes em longo prazo. Os fatores de risco conhecidos são anastomose baixa, radioterapia, lesão direta do nervo e anastomose direta. A fisiopatologia parece multifatorial, com elementos de disfun- ção anatômica, sensorial e da motilidade. O uso de instrumentos validados para avaliação da LARS é essencial. Atualmente, não há comprovações de tratamento da LARS. Ainda hoje, a irrigação transanal e a estimulação do nervo sacral são comprometidas.

Conclusão

A LARS é um problema comum após ressecção com preservação do esfíncter. Todos os pacientes devem ser informados sobre o risco de LARS antes da cirurgia, e o ras- treamento da LARS deve ser rotineiro após a cirurgia. Pacientes com LARS severa devem receber tratamento para melhorar a QdV. O foco futuro deve ser nas possibilidades de tra- tamento sem ressecção a fim de evitar a LARS.

Palavras-chave:
Câncer retal LARS Disfunção intestinal Resultado funcional Qualidade de vida
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