Abstract
Purpose
The impact of the low anterior resection syndrome (LARS) on quality of life has underscored the importance of measuring functional outcomes after treatment for rectal cancer. The aim of this study was to evaluate whether the LARS score as a single questionnaire was useful enough in the clinical setting.
Methods
Patients treated by curative anterior resection for rectal cancer were sent the LARS score and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 questionnaires by post. Patients classified as “minor” and “major” LARS according to the LARS score were visited. Assessment included several scores (Vaizey score, Altomare Obstructed Defecation Syndrome score, Bristol scale). Patients with urgency/faecal incontinence also filled in a bowel diary and the FIQL score.
Results
Seventy patients returned the questionnaires, 49 of whom (“major LARS” and “minor LARS”) were visited and 19 (“no LARS”) were assessed by phone. Four different clinical patterns were identified. The group with urgency/faecal incontinence was the largest (33.8 %), whereas 17.7 % referred evacuatory dysfunction. The LARS score did not correctly evaluate 18 patients: 5 who were classified as no LARS but had severe evacuatory dysfunction and 13 patients categorized as LARS but without significant bowel dysfunction, 9 of whom were classified as major LARS.
Conclusion
The LARS score may overestimate the impact on quality of life in some patients and may underestimate the impact of severe evacuatory dysfunction. Due to the complexity of the LARS, the LARS score as a single questionnaire might not be enough to assess bowel function. A complete clinical evaluation and additional questionnaires might be required.
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References
Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL (2012) Anterior resection syndrome. Lancet Oncol 13:e403–e408
Scheer AS, Boushey RP, Liang S, Doucette S, O’Connor AM, Moher D (2011) The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 54:1589–1597
Chen TY, Emmertsen KJ, Laurberg S (2015) What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Curr Colorectal Cancer Rep 11:37–43
Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR et al (2005) The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 48:1353–1365
Emmertsen KJ, Laurberg S (2012) 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 255:922–928
Juul T, Ahlberg M, Biondo S, Emmertsen KJ, Espin E, Jimenez LM et al (2014) International validation of the low anterior resection syndrome score. Ann Surg 259:728–734
Bregendahl S, Emmertsen KJ, Lous J, Laurberg S (2013) Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Color Dis 15(9):1130–1139
Emmertsen KJ, Laurberg S (2013) Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 100:1377–1387
Juul T, Ahlberg M, Biondo S, Espin E, Jimenez LM, Matzel KE et al (2014) Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum 57:585–591
Chen TY, Wiltink LM, Nout RA, Meershoek-Klein Kranenbarg E, Laurberg S, Marijnen CA et al (2015) 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 14(2):106–114
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) 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 85:365–376
Battersby NJ, Juul T, Christensen P, Janjua AZ, Branagan G, Emmertsen KJ et al (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
Camilleri-Brennan J, Steele RJ (2001) Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. Br J Surg 88:1617–1622
Andreyev HJ, Davidson SE, Gillespie C, Allum WH, Swarbrick E (2012) Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut 61:179–192
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Ribas, Y., Aguilar, F., Jovell-Fernández, E. et al. Clinical application of the LARS score: results from a pilot study. Int J Colorectal Dis 32, 409–418 (2017). https://doi.org/10.1007/s00384-016-2690-7
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DOI: https://doi.org/10.1007/s00384-016-2690-7