Long-term functional follow-up after anterior rectal resection for cancer.
OBJECTIVE
This is a retrospective analysis including all of the patients that have undergone anterior resection for rectal cancer from January 1998 to December 2005 in two tertiary referral centers. The study aims to evaluate the long term functional results after low anterior resection and to identify the risk factors of postoperative bowel disorders.


METHODS
Data were collected from the clinical records, and then the low anterior resection syndrome score which is a specific questionnaire to investigate the symptoms after surgery was submitted to the selected patients. Exclusion criteria were intra-abdominal rectal cancer, partial mesorectal excision, permanent stoma, recurrent local disease, and patients who declined the questionnaire.


RESULTS
A total of 93 patients were included in the analysis with a median age at the diagnosis of 66 years. The median follow-up was 13.7 years, and low anterior resection syndrome was reported in 44 patients (47.5 %), with major manifestations in 19 patients (20.5 %), and minor symptoms in 25 patients (27 %). Age more than 70 years, tumor distance from the external anal verge, neoadjuvant treatment, and interval time of closing stoma are independent prognostic factors of functional disorders after surgery.


CONCLUSIONS
Because of its great impact on the quality of life of these patients, it is necessary to early identify the syndrome trying to reduce its manifestations. Moreover, the symptoms seem to remain stable 1 year after surgery; hence, it is important to have an exhaustive, preoperative counseling and an integrated post-operative functional and rehabilitational follow-up in association with the oncologic pathway.
General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. alexstur@yahoo.it.
Alessandro
http://orcid.org/0000-0002-0845-0933
A
Sturiale
General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy.
Jacopo
J
Martellucci
General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy.
Letizia
L
Zurli
General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy.
Carla
C
Vaccaro
XI Division of General and Obesity Surgery, Second University of Naples, Aversa (CE), Naples, Italy.
Luigi
L
Brusciano
XI Division of General and Obesity Surgery, Second University of Naples, Aversa (CE), Naples, Italy.
Paolo
P
Limongelli
XI Division of General and Obesity Surgery, Second University of Naples, Aversa (CE), Naples, Italy.
Ludovico
L
Docimo
General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy.
Andrea
A
Valeri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012004:Rectal Neoplasms / Q000601:surgery*; D013997:Time Factors
Anterior rectal resection; Fecal incontinence; LARS; PME; Rectal cancer; TME
Curr Colorectal Cancer Rep. 2015;11:37-43
25663833
Med Decis Making. 2008 Nov-Dec;28(6):888-98
18519887
Eur J Cancer Care (Engl). 2006 Jul;15(3):244-51
16882120
Cochrane Database Syst Rev. 2012 Dec 12;12:CD004323
23235607
Dis Colon Rectum. 1998 Jul;41(7):888-91
9678375
Cochrane Database Syst Rev. 2008 Apr 16;(2):CD006040
18425933
N Engl J Med. 2001 Aug 30;345(9):638-46
11547717
Ann Surg Oncol. 2013 Jun;20(6):1816-28
23269466
Cir Esp. 2016 Mar;94(3):137-43
26796026
Am J Gastroenterol. 2002 Sep;97(9):2282-9
12358246
Colorectal Dis. 2013;15(10):e599-606
23869468
Int J Colorectal Dis. 2016 Apr;31(4):813-23
26825055
J Am Coll Surg. 1996 Jun;182(6):495-502
8646349
Ann Surg. 2012 May;255(5):922-8
22504191
Ann Surg. 2014 Apr;259(4):728-34
23598379
Lancet. 2009 Mar 7;373(9666):811-20
19269519
Dis Colon Rectum. 2010 Dec;53(12):1645-51
21178859
Ann Surg. 2007 Sep;246(3):481-8; discussion 488-90
17717452
Ann Surg. 1986 Aug;204(2):133-5
3741004
J Gastrointest Surg. 2015 Feb;19(2):350-9
25326125
Lancet Oncol. 2011 Jun;12(6):575-82
21596621
Br J Surg. 2013 Sep;100(10):1377-87
23939851
Tech Coloproctol. 2016 Apr;20(4):215-20
26754654
Ann Oncol. 2013 Oct;24 Suppl 6:vi81-8
24078665
Ann Med. 1997 Apr;29(2):127-33
9187227
Colorectal Dis. 2003 Mar;5(2):180-4
12780910
J Natl Cancer Inst. 2013 Dec 4;105(23):1806-13
24174654
Dis Colon Rectum. 2016 Apr;59(4):270-80
26953985
Int J Colorectal Dis. 2014 Feb;29(2):165-75
24136155
Eur J Surg Oncol. 2015 Nov;41(11):1493-9
26219852
Lancet Oncol. 2012 Sep;13(9):e403-8
22935240
Dis Colon Rectum. 2011 Dec;54(12):1589-97
22067190
CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
21296855
Radiother Oncol. 2013 Aug;108(2):331-6
23932153
Dis Colon Rectum. 2016 Jan;59(1):79-82
26651116
Colorectal Dis. 2013 Sep;15(9):1130-9
23581977
Clin Colorectal Cancer. 2015 Jun;14(2):106-14
25677122