Exploring the pathophysiology of LARS after low anterior resection for rectal cancer with high-resolution colon manometry.
colon motility
colonic motor patterns
high-resolution manometry
low anterior resection syndrome
rectal cancer
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
16
05
2022
received:
17
02
2022
accepted:
10
06
2022
pubmed:
23
7
2022
medline:
18
10
2022
entrez:
22
7
2022
Statut:
ppublish
Résumé
A total mesorectal excision for rectal cancer-although nerve- and sphincter-sparing-can give rise to significant bowel symptoms, commonly referred to as low anterior resection syndrome (LARS). The exact pathophysiology of this syndrome still remains largely unknown, and the impact of radical surgery on colonic motility has only been scarcely investigated. High-resolution colon manometry was performed in patients, 12-24 months after restoration of transit. Patients were divided into two groups: patients with major LARS and no/minor LARS, according to the LARS-score. Colonic motor patterns were compared, and the relationship of these patterns with the LARS-scores was investigated. Data were analyzed in 18 patients (9 no/minor LARS, 9 major LARS). Cyclic short antegrade motor patterns did occur more in patients with major LARS (total: p = 0.022; post-bisacodyl: p = 0.004) and were strongly correlated to LARS-scores after administering bisacodyl (p < 0.001). High amplitude propagating contractions (HAPC's) that started in the proximal colon and ended in the mid-section of the colon occurred significantly less in patients with major LARS compared with patients with no/minor LARS (p = 0.015). The occurrence of more cyclic short antegrade motor patterns and less HAPC's (from the proximal to the mid-colon) is more prevalent in patients with major LARS. These findings help to understand the differences in pathophysiology in patients developing major versus no/minor bowel complaints after TME for rectal cancer.
Sections du résumé
BACKGROUND
A total mesorectal excision for rectal cancer-although nerve- and sphincter-sparing-can give rise to significant bowel symptoms, commonly referred to as low anterior resection syndrome (LARS). The exact pathophysiology of this syndrome still remains largely unknown, and the impact of radical surgery on colonic motility has only been scarcely investigated.
METHODS
High-resolution colon manometry was performed in patients, 12-24 months after restoration of transit. Patients were divided into two groups: patients with major LARS and no/minor LARS, according to the LARS-score. Colonic motor patterns were compared, and the relationship of these patterns with the LARS-scores was investigated.
KEY RESULTS
Data were analyzed in 18 patients (9 no/minor LARS, 9 major LARS). Cyclic short antegrade motor patterns did occur more in patients with major LARS (total: p = 0.022; post-bisacodyl: p = 0.004) and were strongly correlated to LARS-scores after administering bisacodyl (p < 0.001). High amplitude propagating contractions (HAPC's) that started in the proximal colon and ended in the mid-section of the colon occurred significantly less in patients with major LARS compared with patients with no/minor LARS (p = 0.015).
CONCLUSIONS AND INFERENCES
The occurrence of more cyclic short antegrade motor patterns and less HAPC's (from the proximal to the mid-colon) is more prevalent in patients with major LARS. These findings help to understand the differences in pathophysiology in patients developing major versus no/minor bowel complaints after TME for rectal cancer.
Substances chimiques
Bisacodyl
10X0709Y6I
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14432Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
Borstlap WAA, Deijen CL, den Dulk M, et al. Benchmarking recent national practice in rectal cancer treatment with landmark randomized controlled trials. Colorectal Dis. 2017;19(6):O219-O231.
Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926-1933.
Kusters M, Marijnen CA, van de Velde CJ, et al. Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial. Eur J Surg Oncol. 2010;36(5):470-476.
Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(Suppl_4):iv22-iv40.
Heald RJ. The 'Holy Plane' of rectal surgery. J R Soc Med. 1988;81(9):503-508.
Phang PT. Total mesorectal excision: technical aspects. Can J Surg. 2004;47(2):130-137.
Juul T, Ahlberg M, Biondo S, et al. Low anterior resection syndrome and quality of life: an international multicenter study. Diseases of the Colon & Rectum. 2014;57(5):585-591.
Bregendahl S, Emmertsen KJ, Lous J, Laurberg S. 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.
Emmertsen KJ, Laurberg S, Jess P, et al. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg. 2013;100(10):1377-1387.
Keane C, Fearnhead NS, Bordeianou LG, et al. International consensus definition of low anterior resection syndrome. ANZ J Surg. 2020;90(3):300-307.
Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13(9):e403-e408.
Farouk R, Duthie GS, Lee PW, Monson JR. Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up. Dis Colon Rectum. 1998;41(7):888-891.
Iizuka I, Koda K, Seike K, et al. Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer. Am J Surg. 2004;188(2):176-180.
Emmertsen KJ, Bregendahl S, Fassov J, Krogh K, Laurberg S. A hyperactive postprandial response in the neorectum--the clue to low anterior resection syndrome after total mesorectal excision surgery? Colorectal Dis. 2013;15(10):e599-e606.
Fürst A, Burghofer K, Hutzel L, Jauch K-W. Neorectal reservoir is not the functional principle of the colonic J-pouch. Diseases of the Colon & Rectum. 2002;45(5):660-667.
Planellas P, Farrés R, Cornejo L, et al. Randomized clinical trial comparing side to end vs end to end techniques for colorectal anastomosis. Int J Surg. 2020;83:220-229.
Willis S, Hölzl F, Wein B, Tittel A, Schumpelick V. Defecation mechanisms after anterior resection with J-pouch-anal and side-to-end anastomosis in dogs. Int J Colorectal Dis. 2007;22(2):161-165.
Ridolfi TJ, Berger N, Ludwig KA. Low anterior resection syndrome: current management and future directions. Clin Colon Rectal Surg. 2016;29(3):239-245.
Ziv Y, Zbar A, Bar-Shavit Y, Igov I. Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations. Tech Coloproctol. 2013;17(2):151-162.
Koda K, Saito N, Seike K, Shimizu K, Kosugi C, Miyazaki M. Denervation of the neorectum as a potential cause of defecatory disorder following low anterior resection for rectal cancer. Dis Colon Rectum. 2005;48(2):210-217.
Lee WY, Takahashi T, Pappas T, Mantyh CR, Ludwig KA. Surgical autonomic denervation results in altered colonic motility: an explanation for low anterior resection syndrome? Surgery. 2008;143(6):778-783.
Ho YH, Tan M, Leong AF, Seow-Choen F. Ambulatory manometry in patients with colonic J-pouch and straight coloanal anastomoses: randomized, controlled trial. Dis Colon Rectum. 2000;43(6):793-799.
Huge A, Kreis ME, Zittel TT, Becker HD, Starlinger MJ, Jehle EC. Postoperative colonic motility and tone in patients after colorectal surgery. Dis Colon Rectum. 2000;43(7):932-939.
Corsetti M, Costa M, Bassotti G, et al. First translational consensus on terminology and definitions of colonic motility in animals and humans studied by manometric and other techniques. Nat Rev Gastroenterol Hepatol. 2019;16(9):559-579.
Pannemans J, Vanuytsel T, Pauwels A, et al. Interobserver analysis trial on colonic motor pattern recognition for high-resolution colonic manometry. Gastroenterology. 2019;156(6):S595-S595.
Keane C, Paskaranandavadivel N, Vather R, et al. Altered colonic motility is associated with low anterior resection syndrome. Colorectal Dis. 2021;23(2):415-423.
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.
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.
Hupkens BJP, Breukink SO, Olde Reuver Of C, et al. Dutch validation of the low anterior resection syndrome score. Colorectal Dis. 2018;20(10):881-887.
Fleiss JL. Design and Analysis of Clinical Experiments. Vol 73. John Wiley & Sons; 2011.
Juul T, Ahlberg M, Biondo S, et al. International validation of the low anterior resection syndrome score. Ann Surg. 2014;259(4):728-734.
Al-Saidi AM, Verkuijl SJ, Hofker S, Trzpis M, Broens PM. How should the low anterior resection syndrome score be interpreted? Diseases of the Colon & Rectum. 2020;63(4):520-526.
Dinning PG, Wiklendt L, Maslen L, et al. Quantification of in vivo colonic motor patterns in healthy humans before and after a meal revealed by high-resolution fiber-optic manometry. Neurogastroenterol Motil. 2014;26(10):1443-1457.
Lin AY, Du P, Dinning PG, et al. High-resolution anatomic correlation of cyclic motor patterns in the human colon: evidence of a rectosigmoid brake. Am J Physiol Gastrointest Liver Physiol. 2017;312(5):G508-g515.
Ng K, Russo R, Gladman M. Colonic transit in patients after anterior resection: prospective, comparative study using single-photon emission CT/CT scintigraphy. J Br Surg. 2020;107(5):567-579.
Manabe N, Cremonini F, Camilleri M, Sandborn W, Burton D. Effects of bisacodyl on ascending colon emptying and overall colonic transit in healthy volunteers. Aliment Pharmacol Ther. 2009;30(9):930-936.