Rectal Cancer Clinical Trial
Official title:
Anterior Resection Syndrome Following Sphincter-preserving Surgery
Bowel cancer is the third most common cancer in the UK in both males and females. The rectum
is the most commonly affected part of the bowel. Improvements in surgery have meant that
many patients with rectal cancer can now undergo surgery that removes the rectum and avoids
a permanent stoma. The operation that most patients have is an anterior resection of the
rectum.
Unfortunately this surgery frequently leads to a change in bowel function, with patients
suffering from incontinence, urgency and unpredictability a problem known as anterior
resection syndrome. These problems are believed to be fairly common following surgery but
follow up appointments have traditionally concentrated on ensuring that the cancer has not
returned and have not reviewed functional outcomes in enough detail. Because of this we are
unsure exactly how common the problems described are.
The proposed study will allow us to determine how many patients have ongoing symptoms
following their surgery for rectal cancer. It will also allow us to use a newly developed
scoring system the Low Anterior Resection Syndrome (LARS) score for the first time in a UK
population, to ensure that it can accurately be used in the future to measure the problem
and aid development of new therapies. An appreciation of the impact of symptoms on
postoperative quality of life will encourage routine assessment of functional outcomes in
clinical practice, allowing identification of patients who may benefit from treatment.
One of the main aims when carrying out surgery for rectal cancer is to avoid patients ending
up with a permanent stoma. The current standard operation for resection of the rectum is an
anterior resection. A large proportion of the patients undergoing this procedure develop
anterior resection syndrome, with significant alteration of their bowel habit, including
urgency, incontinence and unpredictability. Many definitions for this problem have been used
and until recently there was no specifically designed tool for measuring it. There has never
been a large scale study in the UK to tell us how common the problem is. A meta-analysis
combining results from small studies show marked variation in the frequency of symptoms
ranging from 285%, mainly because of the different methods of assessment used in the
studies.
The LARS score was recently developed by a research group in Denmark. Their results show
that 45.9% of patients had major LARS at 12 months following surgery. This is nearly half of
all patients in their sample and clearly represents an important problem.
Anterior resection syndrome is known to have a negative effect on quality of life. It is a
multifactorial condition and is increased in patients have chemotherapy and radiotherapy.
There are treatments available and also in development which may help patients. However in
clinical practice, patients are not routinely asked about their functional outcome and the
effect that these symptoms can have on patients' lives is often not discussed. The urgent
need for further research into the longterm functional effects of treatments for cancer has
been acknowledged by the National Institute for Health and Care Excellence (NICE) and the
National Cancer Survivorship Initiative.
Determining baseline prevalence in the UK and validating the LARS score will allow accurate
preoperative counselling of patients about functional outcomes following surgery for rectal
cancer. It will facilitate comparison between populations, further helping to determine risk
factors and aiding in development of therapeutic interventions. An appreciation of the
impact of anterior resection syndrome on postoperative quality of life will encourage
routine assessment of functional outcomes in clinical practice, allowing identification of
patients who may benefit from treatment.
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