Quality of Life in Patients with Low Anterior Resection

Öz

The aim of this study is to evaluate the relationship between Low Anterior Resection Syndrome (LARS) and quality of life (QOL). Patients who had operated on in our clinic due to rectal cancer were included in the study. In total 52 patients underwent rectal resection between the study period, 24 patients were excluded from the study, 28 patients included in the study. Quality of life (QOL), European cancer quality of life research and treatment survey-C30 (EORTC QLQ C-30), and bowel functions were evaluated using LARS score. In our clinic, between 19th January 2017 and 31th March 2019, all patients who were operated on due to rectum cancer and who underwent sphincter sparing procedures were taken from the prospective database. Patients who continued their follow-up in our outpatient clinic and wanted to participate in the survey were included in the study, and face-to-face surveys were carried out with them. The relationship between LARS and QOL was analyzed. The percentage of the patients who had major LARS is %53.7. QOL was closely related to LARS. There was a significant difference between patients with Major LARS and patients without major LARS in their global health status and functional scale (physical, role, emotional, cognitive, social) Patients with Major LARS had more diarrhea, fatigue, insomnia, and pain. Anastomosis level (low) was an important risk factor for major LARS (p<0.001). More than half of the patients had major LARS. Patients with Major LARS had lower QOL than patients with no/minor LARS. The presence of major LARS after rectal resection for cancer is negatively related to global health as well as many other aspects of QOL (p<0.001). Maintaining anorectal function and treating LARS are potential measures to improve QOL in this patient group.

Anahtar Kelimeler

• Rectum
• cancer
• oncology
• surgery
• low anterior resection

Low Anterior Rezeksiyon Yapılan Hastalarda Hayat Kalitesi

Öz

Bu çalışmanın amacı Low Anterior Rezeksiyon Sendromu (LARS) ile yaşam kalitesi (QOL) arasındaki ilişkiyi değerlendirmektir. Kliniğimizde rektum kanseri nedeniyle ameliyat olan hastalar çalışmaya dahil edildi. Çalışma periyodu arasında toplam 52 hastaya rektal rezeksiyon uygulandı, 24 hasta çalışma dışı bırakıldı, 28 hasta çalışmaya dahil edildi. Yaşam kalitesi (QOL), Avrupa kanser yaşam kalitesi araştırma ve tedavi anketi-C30 (EORTC QLQ C-30) ve bağırsak fonksiyonları LARS skoru kullanılarak değerlendirildi. Kliniğimizde 19 Ocak 2017-31 Mart 2019 tarihleri arasında rektum kanseri nedeniyle ameliyat edilen ve sfinkter koruyucu cerrahi uygulanan tüm hastalar retrospektif veri tabanından alınmıştır. Polikliniğimizde takiplerine devam eden ve ankete katılmak isteyen hastalar çalışmaya dahil edilmiş ve hastalarla yüz yüze anket yapılmıştır. LARS ve QOL arasındaki ilişki analiz edilmiştir. Majör LARS olan hastaların oranı %53,7'dir. QOL, LARS ile yakından ilişkiliydi. Majör LARS hastaları ile majör LARS olmayan hastalar arasında global sağlık durumları ve fonksiyonel ölçekleri (fiziksel, rol, duygusal, bilişsel, sosyal) açısından anlamlı bir fark vardı. Anastomoz seviyesi (alçak anastomoz) majör LARS için önemli bir risk faktörüydü (p<0,001). Hastaların yarısından fazlasında majör LARS vardı. Majör LARS hastalarının yaşam kalitesi, LARS olmayan/minör hastalara göre daha düşüktü. Kanser için rektal rezeksiyondan sonra majör LARS varlığı, QOL ölçeğinin diğer birçok parametresi gibi genel sağlık durumuyla da negatif ilişkilidir (p<0,001). LARS yaşam kalitesini etkileyebilir. Bu nedenle rektum kanserinden tedavi olan hastalarda fonksiyonel problemlere odaklanmak gerekir. Anorektal fonksiyonun sürdürülmesi ve LARS tedavisi bu hasta grubunda yaşam kalitesini iyileştirmeye yönelik potansiyel önlemlerdir.

Anahtar Kelimeler

• Rektum
• kanser
• cerrahi
• onkoloji
• low anterior rezeksiyon

Kaynakça

1. Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK (1998) The Basingstoke Experience of total mesorectal excision. Arch Surg 133:894–899
2. Birgisson H, Talbäck M, Gunnarsson U, Påhlman L, Glimelius B (2005) Improved survival in cancer of the colon and rectum in Sweden. Eur J Surg Oncol 31:845–853
3. Cornish, J.A., Tilney, H.S., Heriot, A.G., Lavery, I.C., Fazio, V.W., Tekkis, P.P., 2007. A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Ann. Surg Oncol. 14, 2056–20684.
4. Kupsch J, Jackisch T, Matzel KE, Zimmer J, Schreiber A, Sims A, Witzigmann H, Stelzner S (2018) Outcome of bowel function following anterior resection for rectal cancer—an analysis using the Low Anterior Resection Syndrome (LARS) score. Int J Color Dis 33:787–798
5. Juul T, Ahlberg M, Biondo S, Espin E, Jimenez LM, Matzel KE, Palmer GJ, Sauermann A, Trenti L, Zhang W, Laurberg S, Christensen P (2014) International validation of the Low Anterior Resection Syndrome Score. Ann Surg 259:728–734
6. 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; 14:106.
7. Battersby NJ, Juul T, Christensen P, Janjua AZ, Branagan G, Emmertsen KJ, Norton C, Hughes R, Laurberg S, Moran BJ, United Kingdom Low Anterior Resection Syndrome Study Group (2016) Predicting the risk of bowel-related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis Colon Rectum 59:270–2807
8. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomly A, on behalf of the EORTC Quality of Life Group (2001) The EORTC QLQ-C30 Scoring Manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels

9. Juliane Kupsch ,Matthias Kuhn , Klaus E. Matzel , Joerg Zimmer , Olga Radulova-Mauersberger ,Anja Sims , Helmut Witzigmann , Sigmar Stelzner(2019) To what extent is the low anterior resection syndrome (LARS) associated with quality of life as measured using the EORTC C30 and CR38 quality of life questionnaires International Journal of Colorectal Disease (2019) 34:747–762
10. 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.
11. Temple LK, Bacik J, Savatta SG, et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum. 2005;48(7):1353-1365.
12. Scott NW, Fayers PM, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Sprangers MAG (2008) EORTC QLQ-C30 Reference Values. European Organisation for Research and Treatment of Cancer, Brussels
13. Juul, T., Ahlberg, M., Biondo, S., Espin, E., Jimenez, L.M., Matzel, K.E., Palmer, G.J., Sauermann, A., Trenti, L., Zhang, W., Laurberg, S., Christensen, P., 2014. Low anterior resection syndrome and quality of life: an international multicenter study. Dis. Colon Rectum 57, 585–591.
14. E. Pape , P. Pattyn , A. Van Hecke , N. Somers , D. Van de Putte , W. Ceelen , E. Van Daele , W. Willaert , K. Geboes , Y. Van Nieuwenhove, Impact of low anterior resection syndrome (LARS) on the quality of life and treatment options of LARS - A cross sectional study European Journal of Oncology Nursing 50 (2021) 101878
15. Emmertsen KJ, Laurberg S, on behalf of the Rectal Cancer Function Study Group (2013) Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 100:1377–1387
16. Battersby, N.J., Juul, T., Christensen, P., Janjua, A.Z., Branagan, G., Emmertsen, K.J., Norton, C., Hughes, R., Laurberg, S., Moran, B.J., 2016. Predicting the risk of bowel- related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis. Colon Rectum 59, 270–280.
17. Emmertsen, K.J., Chen, T.Y.-T., Laurberg, S., 2014. Functional results after treatment for rectal cancer. J Coloproctol 34, 55–61.
18. Juul, T., Ahlberg, M., Biondo, S., Espin, E., Jimenez, L.M., Matzel, K.E., Palmer, G.J., Sauermann, A., Trenti, L., Zhang, W., Laurberg, S., Christensen, P., 2014. Low anterior resection syndrome and quality of life: an international multicenter study. Dis. Colon Rectum 57, 585–591.
19. Krouse RS, Wendel CS, Garcia DO, et al. . Physical activity, bowel function, and quality of life among rectal cancer survivors. Qual Life Res 2017;26:3131–42.10.1007/s11136-017-1641-2
20. Scheer AS, Boushey RP, Liang S, et al. . The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 2011;54:1589–97.10.
21. Matzel, K., Stadelmaier, U., Muehldorfer, S., Hohenberger, W., 1997. Continence after colorectal reconstruction following resection: impact of level of anastomosis. Int. J. Colorectal Dis. 12, 82–87
22. Nesbakken A, Nygaard K, Lunde OC (2001) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88:400–404
23. Kneist W, Kauff DW, Juhre V, Hoffmann KP, Lang H (2013) Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME? Results of a casecontrol study. Eur J Surg Oncol 39:994–9992
24. Koedam TWA, van Ramshorst GH, Deijen CL, Elfrink AKE, Meijerink WJHJ, Bonjer HJ, Sietses C, Tuynman JB (2017) Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol 21:25–33
25. Luca F, ValvoM, Guerra-Cogorno M, Simo D, Blesa-Sierra E, Biffi R, Garberoglio C (2016) Functional results of robotic total intersphincteric resection with hand-sewn coloanal anastomosis. Eur J Surg Oncol 42:841–847.
26. Andersson J, Angenete E, Gellerstedt M, Angerås U, Jess P, Rosenberg J, Fürst A, Bonjer J, Haglind E (2013) Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg 100:941–949
27. Bondeven, P., Emmertsen, K., Laurberg, S., Pedersen, B., 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, 1493–1499
28. Ihnát P, Slívová I, Tulinsky L, et al. Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study). J Surg Oncol 2018; 117:710.
29. Juul T, Elfeki H, Christensen P, Laurberg S, Emmertsen KJ, Bager P. Normative Data for the Low Anterior Resection Syndrome Score (LARS Score). Ann Surg. 2019;269(6):1124-1128.