The effect of the severity of low anterior resection syndrome on the quality of life in patients with rectal cancer: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Yilin ¹ ,  HUANG Mingjun ² , XIONG Fangli ¹ , YU He ³ , WANG Xiaodong ⁴

1. West China Hospital/West China School of Nursing, Sichuan University, Chengdu 610041, P. R. China;
2. Day Service Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. West China School of Clinical Medicine, Sichuan University, Chengdu 610041, P. R. China;
4. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

HUANG Mingjun, Email: hmj123123@126.com

Keywords：

rectal cancer; low anterior resection syndrome; quality of life; meta-analysis

DOI：

10.7507/1007-9424.202105077

Video：

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Objective To explore the impact of the severity of low anterior resection syndrome (LARS) on the quality of life in patients with rectal cancer. Methods Literatures published from January 2012 to August 2020 in the Cochrane Library, PubMed, Embase, CNKI, WanFang and other databases were searched according to the search terms. Study screened, data extracted, and quality evaluated were conducted by three reviewers independently, and the RevMan 5.4 software was used for meta-analysis. Results Seven studies, involving 1 616 patients were included. Meta-analysis results showed that the functional scores (including overall health status, physiological functioning, role functioning, emotional functioning, cognitive functioning, and social functioning) of patients with major LARS were lower than those of patients with no/minor LARS (P<0.001). Except for appetite loss, the symptom score (including fatigue, nausea and vomiting, pain), shortness of breath, insomnia, constipation, diarrhea, and financial difficulties of patients with major LARS were higher than those of patients with no/minor LARS (P<0.01). Conclusion Major LARS has a greater impact on the quality of life of patients after surgery than no/minor LARS.

Citation： WANG Yilin, HUANG Mingjun, XIONG Fangli, YU He, WANG Xiaodong. The effect of the severity of low anterior resection syndrome on the quality of life in patients with rectal cancer: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(2): 179-187. doi: 10.7507/1007-9424.202105077 Copy

1.	鄭民華, 馬君俊. 微創技術在結直腸腫瘤手術功能保護的優勢與弊端. 中華胃腸外科雜志, 2017, 20(6): 601-605.
2.	Bregendahl S, Emmertsen KJ, Lous J, et al. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis, 2013, 15(9): 1130-1139.
3.	蒲羽, 邱遠, 李祥, 等. 直腸癌保肛術后低位前切除綜合征發生率、恢復情況及影響因素的回顧性分析. 第三軍醫大學學報, 2017, 39(10): 1025-1030.
4.	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, 2016, 39(4): 225-231.
5.	中華人民共和國國家衛生健康委員會醫政醫管局, 中華醫學會腫瘤學分會. 中國結直腸癌診療規范(2020年版). 中國實用外科雜志, 2020, 40(6): 601-625.
6.	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.
7.	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.
8.	Gujral S, Conroy T, Fleissner C, et al. 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.	Wells GA, Shea B, Connell D, et al. The Newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
10.	Carpelan A, Elamo E, Karvonen J, et al. Validation of the low anterior resection syndrome score in finnish patients: preliminary results on quality of life in different LARS severity groups. Scand J Surg, 2021, 110(3): 414-419.
11.	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.
12.	Emmertsen KJ, Laurberg S. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg, 2013, 100(10): 1377-1387.
13.	Kupsch J, Kuhn M, Matzel KE, et al. 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? Int J Colorectal Dis, 2019, 34(4): 747-762.
14.	Pieniowski EHA, Nordenvall C, Palmer G, et al. Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study. BJS Open, 2020, 4(5): 935-942.
15.	Ribas Y, Aguilar F, Jovell-Fernández E, et al. Clinical application of the LARS score: results from a pilot study. Int J Colorectal Dis, 2017, 32(3): 409-418.
16.	徐玲, 丁曙晴, 丁義江. 直腸癌前切除術后生活質量及前切除綜合征相關因素分析. 臨床外科雜志, 2019, 27(12): 1049-1052.
17.	顧晉, 潘宏達. 直腸前切除綜合征的防范與處理. 中華胃腸外科雜志, 2016, 19(4): 366-369.
18.	Kornmann VN, Walma MS, de Roos MA, et al. Quality of life after a low anterior resection for rectal cancer in elderly patients. Ann Coloproctol, 2016, 32(1): 27-32.
19.	Battersby NJ, Juul T, Christensen P, et al. Predicting the risk of bowel-related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis Colon Rectum, 2016, 59(4): 270-280.
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(12): 1589-1597.
21.	Pieniowski EHA, Palmer GJ, Juul T, et al. Low anterior resection syndrome and quality of life after sphincter-sparing rectal cancer surgery: a long-term longitudinal follow-up. Dis Colon Rectum, 2019, 62(1): 14-20.
22.	van Heinsbergen M, Janssen-Heijnen ML, Leijtens JW, et al. Bowel dysfunction after sigmoid resection underestimated: multicentre study on quality of life after surgery for carcinoma of the rectum and sigmoid. Eur J Surg Oncol, 2018, 44(8): 1261-1267.
23.	Pucciarelli S, Del Bianco P, Efficace F, et al. Health-related quality of life, faecal continence and bowel function in rectal cancer patients after chemoradiotherapy followed by radical surgery. Support Care Cancer, 2010, 18(5): 601-608.
24.	Juul T, Ahlberg M, Biondo S, et al. Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum, 2014, 57(5): 585-591.
25.	謝玲女, 姚曉, 溫春美, 等. 直腸癌LARS相關生活質量的質性研究. 2016浙江省腫瘤外科學術年會暨第二屆錢江國際腫瘤外科高峰論壇論文匯編. 2016: 4.
26.	Bohlok A, Mercier C, Bouazza F, et al. The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer. Support Care Cancer, 2020, 28(3): 1199-1206.
27.	丁玉珍, 孫琳, 沈旻靜, 等. Kegel運動聯合水療法對直腸癌患者術后發生低位直腸前切除綜合征及生命質量的臨床效果研究. 中國全科醫學, 2018, 21(14): 1677-1681.
28.	吳曉丹, 符春鳳, 陳依琳, 等. 生物反饋聯合盆底肌鍛煉對直腸癌低位保肛患者低位前切除綜合征的作用. 中華醫學雜志, 2019, 99(30): 2337-2343.
29.	許巖磊. 針灸促進直腸癌前切除術后排便功能恢復的研究. 南京: 南京中醫藥大學, 2013.
30.	許燕飛. 個體化生物反饋訓練對直腸癌保肛術后肛門直腸動力學和肛門排便功能的影響. 中國實用護理雜志, 2020, 36(21): 1612-1617.
31.	雷亞楠, 丁健華, 卓光鑽, 等. 直腸癌前切除綜合征的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(7): 809-812.
32.	蔣偉, 官海迪, 邱遠, 等. 直腸癌術后低位前切除綜合征的評估與治療進展. 中國普外基礎與臨床雜志, 2020, 27(5): 624-628.

1. 鄭民華, 馬君俊. 微創技術在結直腸腫瘤手術功能保護的優勢與弊端. 中華胃腸外科雜志, 2017, 20(6): 601-605.
2. Bregendahl S, Emmertsen KJ, Lous J, et al. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis, 2013, 15(9): 1130-1139.
3. 蒲羽, 邱遠, 李祥, 等. 直腸癌保肛術后低位前切除綜合征發生率、恢復情況及影響因素的回顧性分析. 第三軍醫大學學報, 2017, 39(10): 1025-1030.
4. 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, 2016, 39(4): 225-231.
5. 中華人民共和國國家衛生健康委員會醫政醫管局, 中華醫學會腫瘤學分會. 中國結直腸癌診療規范(2020年版). 中國實用外科雜志, 2020, 40(6): 601-625.
6. 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.
7. 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.
8. Gujral S, Conroy T, Fleissner C, et al. 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. Wells GA, Shea B, Connell D, et al. The Newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
10. Carpelan A, Elamo E, Karvonen J, et al. Validation of the low anterior resection syndrome score in finnish patients: preliminary results on quality of life in different LARS severity groups. Scand J Surg, 2021, 110(3): 414-419.
11. 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.
12. Emmertsen KJ, Laurberg S. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg, 2013, 100(10): 1377-1387.
13. Kupsch J, Kuhn M, Matzel KE, et al. 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? Int J Colorectal Dis, 2019, 34(4): 747-762.
14. Pieniowski EHA, Nordenvall C, Palmer G, et al. Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study. BJS Open, 2020, 4(5): 935-942.
15. Ribas Y, Aguilar F, Jovell-Fernández E, et al. Clinical application of the LARS score: results from a pilot study. Int J Colorectal Dis, 2017, 32(3): 409-418.
16. 徐玲, 丁曙晴, 丁義江. 直腸癌前切除術后生活質量及前切除綜合征相關因素分析. 臨床外科雜志, 2019, 27(12): 1049-1052.
17. 顧晉, 潘宏達. 直腸前切除綜合征的防范與處理. 中華胃腸外科雜志, 2016, 19(4): 366-369.
18. Kornmann VN, Walma MS, de Roos MA, et al. Quality of life after a low anterior resection for rectal cancer in elderly patients. Ann Coloproctol, 2016, 32(1): 27-32.
19. Battersby NJ, Juul T, Christensen P, et al. Predicting the risk of bowel-related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis Colon Rectum, 2016, 59(4): 270-280.
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(12): 1589-1597.
21. Pieniowski EHA, Palmer GJ, Juul T, et al. Low anterior resection syndrome and quality of life after sphincter-sparing rectal cancer surgery: a long-term longitudinal follow-up. Dis Colon Rectum, 2019, 62(1): 14-20.
22. van Heinsbergen M, Janssen-Heijnen ML, Leijtens JW, et al. Bowel dysfunction after sigmoid resection underestimated: multicentre study on quality of life after surgery for carcinoma of the rectum and sigmoid. Eur J Surg Oncol, 2018, 44(8): 1261-1267.
23. Pucciarelli S, Del Bianco P, Efficace F, et al. Health-related quality of life, faecal continence and bowel function in rectal cancer patients after chemoradiotherapy followed by radical surgery. Support Care Cancer, 2010, 18(5): 601-608.
24. Juul T, Ahlberg M, Biondo S, et al. Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum, 2014, 57(5): 585-591.
25. 謝玲女, 姚曉, 溫春美, 等. 直腸癌LARS相關生活質量的質性研究. 2016浙江省腫瘤外科學術年會暨第二屆錢江國際腫瘤外科高峰論壇論文匯編. 2016: 4.
26. Bohlok A, Mercier C, Bouazza F, et al. The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer. Support Care Cancer, 2020, 28(3): 1199-1206.
27. 丁玉珍, 孫琳, 沈旻靜, 等. Kegel運動聯合水療法對直腸癌患者術后發生低位直腸前切除綜合征及生命質量的臨床效果研究. 中國全科醫學, 2018, 21(14): 1677-1681.
28. 吳曉丹, 符春鳳, 陳依琳, 等. 生物反饋聯合盆底肌鍛煉對直腸癌低位保肛患者低位前切除綜合征的作用. 中華醫學雜志, 2019, 99(30): 2337-2343.
29. 許巖磊. 針灸促進直腸癌前切除術后排便功能恢復的研究. 南京: 南京中醫藥大學, 2013.
30. 許燕飛. 個體化生物反饋訓練對直腸癌保肛術后肛門直腸動力學和肛門排便功能的影響. 中國實用護理雜志, 2020, 36(21): 1612-1617.
31. 雷亞楠, 丁健華, 卓光鑽, 等. 直腸癌前切除綜合征的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(7): 809-812.
32. 蔣偉, 官海迪, 邱遠, 等. 直腸癌術后低位前切除綜合征的評估與治療進展. 中國普外基礎與臨床雜志, 2020, 27(5): 624-628.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The effect of the severity of low anterior resection syndrome on the quality of life in patients with rectal cancer: a meta-analysis

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