The Longitudinal Course of Low-anterior Resection Syndrome: An individual Patient Meta-analysis.
Ann Surg
; 276(1): 46-54, 2022 07 01.
Article
em En
| MEDLINE
| ID: mdl-35185131
ABSTRACT
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 18-24âmonths.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 36âmonths (95% confidence interval 14.2%-18.9%). On multivariable analysis, a greater improvement in mean LARS score between baseline and 12âmonths 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 18-24âmonths 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 18âmonths postoperatively then remains stable for up to 3âyears. Total mesorectal excision, neoadjuvant radiotherapy, and ileostomy formation negatively impact upon bowel function recovery.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doenças Retais
/
Neoplasias Retais
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Adult
/
Humans
Idioma:
En
Revista:
Ann Surg
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Nova Zelândia