Table 1.
Selected literature on functional outcomes after a low anterior resection
| Study | Surgical procedure | Bowel function evaluation | Functional outcomes |
|---|---|---|---|
| Kakodkar et al. [35] | LAR with TME (CAA) | Anorectal manometry | Frequency: 3.3 ± 0.17 |
| Wexner continence questionnaire | MBP (cmH2O): 37.7 ± 0.41 | ||
| MSP (cmH2O): 76.6 ± 0.54 | |||
| MTV (mL): 146.3 ± 4.06 | |||
| Compliance (mL/cmH2O): 3.83 ± 0.27 | |||
| RAIR – absent in half | |||
| Wexner score: 4.37 ± 0.2 | |||
| Akagi et al. [36] | ISR | Anorectal manometry | Frequency: 5.1 (1–20) |
| Wexner continence questionnaire | MBP (cmH2O): 41 (4–84) | ||
| MSP (cmH2O): 178 (20–346) | |||
| Wexner score: 7.2 (1–20) | |||
| Patient satisfaction (%) | |||
| -Very low 8.8 | |||
| -Medium 19.3 | |||
| -Perfect 71.9 | |||
| Dulskas and Samalavicius [37] | LAR with TME | Anorectal manometry | Frequency: 3.3 ± 0.17 |
| Wexner continence questionnaire | MBP (cmH2O): 43 ± 5.7 | ||
| MSP (cmH2O): 100 ± 8.9 | |||
| MTV (mL): 140 ± 8.2 | |||
| Wexner score: 6.3 (mean score) | |||
| Shibata et al. [38] | LAR with TME (CAA and intraoperative radiation) | MSKCC Sphincter Function Scale | More than one-half of the patients treated by sphincter preservation, EBRT, IORT, and chemotherapy had an unfavorable functional outcome. |
| -EORTC QLQ-C30 | |||
| Emmertsen et al. [10] | LAR | LARS score | Higher risk of major LARS with neoadjuvant therapy af- ter TME and with temporary diverting stoma |
| -TME vs. PME | European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 | LARS score has high sensitivity and specificity for iden- tifying patients with major bowel dysfunction causing impairment of QoL | |
| -Neoadjuvant vs. no Neoadjuvant | |||
| Juul et al. [39] | LAR (no stoma) | LARS score | Patients with major LARS fare substantially worse in 7 of the 8 EORTC QLQ-C30 compared with patients with no/minor LARS. |
| EORTC QLQ-C30 | |||
| Qin et al. [40] | LAR | LARS score | nCRT had a higher risk of developing major LARS than nCT alone |
| -nCRT vs nCT | Postoperative pelvic MRI |
| Manometry parameter | Normal value | Wexner score |
|---|---|---|
| MBP | 40–70 mmHg | 0 = perfect continence |
| MSP | 80–160 mmHg | 20 = complete incontinence |
| MTV | >160 mL |
LAR with TME, low anterior resection with total mesorectal excision; CAA, coloanal anastomosis; ISR, intersphincteric resection; MSKCC, Memorial Sloan-Kettering Cancer Center bowel function instrument; (EORTC) QLQ-C30, European organization for research and treatment of cancer; LARS score, low anterior resection syndrome score; MRI, magnetic resonance imaging; MBP, mean basal pressure; MSP, mean squeezing pressure; MTV, maximum total volume; RAIR, rectoanal inhibitory reflex; EBRT, external beam radiation therapy; IORT, intraoperative radiation therapy; QoL, quality of life; nCRT, neoadjuvant chemoradiotherapy; nCT, neo-adjuvant chemotherapy.