The Longitudinal Course of Low-anterior Resection Syndrome: An individual Patient Meta-analysis.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
pubmed:
22
2
2022
medline:
14
7
2022
entrez:
21
2
2022
Statut:
ppublish
Résumé
We aimed to better understand the longitudinal course of low anterior resection syndrome (LARS) to guide patient expectations and identify those at risk of persisting dysfunction. LARS describes disordered bowel function after rectal resection that significantly impacts quality of life. MEDLINE, EMBASE, CENTRAL, and CINAHL databases were systematically searched for studies that enrolled adults undergoing anterior resection for rectal cancer and used the LARS score to assess bowel function at ≥2 postoperative time points. Regression analyses were performed on deidentified patient-level data to identify predictors of change in LARS score from baseline (3-6months) to 12-months and 18-24 months. Eight studies with a total of 701 eligible patients were included. The mean LARS score improved over time, from 29.4 (95% confidence interval 28.6-30.1) at baseline to 16.6 at 36 months (95% confidence interval 14.2%-18.9%). On multivariable analysis, a greater improvement in mean LARS score between baseline and 12 months was associated with no ileostomy formation [mean difference (MD) -1.7 vs 1.7, P < 0.001], and presence of LARS (major vs minor vs no LARS) at baseline (MD -3.8 vs -1.7 vs 5.4, P < 0.001). Greater improvement in mean LARS score between baseline and 18-24 months was associated with partial mesorectal excision vs total mesorectal excision (MD-8.6 vs 1.5, P < 0.001) and presence of LARS (major vs minor vs no LARS) at baseline (MD -8.8 vs -5.3 vs 3.4, P < 0.001). LARS improves by 18 months postoperatively then remains stable for up to 3 years. Total mesorectal excision, neoadjuvant radiotherapy, and ileostomy formation negatively impact upon bowel function recovery.
Sections du résumé
OBJECTIVE
We aimed to better understand the longitudinal course of low anterior resection syndrome (LARS) to guide patient expectations and identify those at risk of persisting dysfunction.
SUMMARY BACKGROUND DATA
LARS describes disordered bowel function after rectal resection that significantly impacts quality of life.
METHODS
MEDLINE, EMBASE, CENTRAL, and CINAHL databases were systematically searched for studies that enrolled adults undergoing anterior resection for rectal cancer and used the LARS score to assess bowel function at ≥2 postoperative time points. Regression analyses were performed on deidentified patient-level data to identify predictors of change in LARS score from baseline (3-6months) to 12-months and 18-24 months.
RESULTS
Eight studies with a total of 701 eligible patients were included. The mean LARS score improved over time, from 29.4 (95% confidence interval 28.6-30.1) at baseline to 16.6 at 36 months (95% confidence interval 14.2%-18.9%). On multivariable analysis, a greater improvement in mean LARS score between baseline and 12 months was associated with no ileostomy formation [mean difference (MD) -1.7 vs 1.7, P < 0.001], and presence of LARS (major vs minor vs no LARS) at baseline (MD -3.8 vs -1.7 vs 5.4, P < 0.001). Greater improvement in mean LARS score between baseline and 18-24 months was associated with partial mesorectal excision vs total mesorectal excision (MD-8.6 vs 1.5, P < 0.001) and presence of LARS (major vs minor vs no LARS) at baseline (MD -8.8 vs -5.3 vs 3.4, P < 0.001).
CONCLUSIONS
LARS improves by 18 months postoperatively then remains stable for up to 3 years. Total mesorectal excision, neoadjuvant radiotherapy, and ileostomy formation negatively impact upon bowel function recovery.
Identifiants
pubmed: 35185131
doi: 10.1097/SLA.0000000000005423
pii: 00000658-202207000-00008
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
46-54Investigateurs
Arsen Rasulov
(A)
Aslan Baychorov
(A)
Chris Frampton
(C)
Dominic Chi-Chung Foo
(DC)
Emil Pieniowski
(E)
Mirna-Nordling Abraham
(MN)
George Theodoropoulos
(G)
Grace McCutchan
(G)
Harald R Rosen
(HR)
Irene Vogel
(I)
James Holden
(J)
Jason Park
(J)
Julie Cornish
(J)
Karin Haustermans
(K)
Katrine Emmertsen
(K)
Lien Smets
(L)
Sanne Harslof
(S)
Soren Laurberg
(S)
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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