A Systematic Review of Comparative Effectiveness of Interventions for Low Anterior Resection Syndrome: Impacts on Bowel Function and Quality of Life.

Autor:	Ansar M; General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.; General Surgery, Wirral University Teaching Hospital, Wirral, GBR., Boddeti S; Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Noor K; Foundation of Clinical Research, Harvard Medical School, Boston, USA.; Neuropsychiatry, PsychCare Consultant Research, Saint Louis, USA.; Internal Medicine, Shadan Institute of Medical Sciences, Peeramcheru, IND., Malireddi A; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Abera M; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Suresh SB; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.; Internal Medicine, Montefiore Medical Center, Wakefield Campus, Newburgh, USA., Malasevskaia I; Obstetrics and Gynecology, Private Clinic 'Yana Alexandr', Sana'a, YEM.; Research and Development, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Oct 31; Vol. 16 (10), pp. e72772. Date of Electronic Publication: 2024 Oct 31 (Print Publication: 2024).
DOI:	10.7759/cureus.72772
Abstrakt:	Low anterior resection syndrome (LARS) is a common complication following sphincter-preserving surgical resection for rectal cancer, characterized by symptoms such as fecal incontinence, urgency, and altered bowel habits, which significantly affect patients' quality of life. This cluster of symptoms not only limits their day-to-day physical activity but also has a debilitating effect on their emotional and mental well-being, undermining their integration and overall psychological health. This systematic review aimed to evaluate the effectiveness of invasive and non-invasive interventions for LARS, including pelvic floor rehabilitation, transanal irrigation, and various surgical options such as sacral neuromodulation and stoma formation, either as part of primary surgery or as a definitive treatment option for refractory cases. We systematically searched relevant databases for studies published in the last decade, focusing on adult patients diagnosed with LARS post-low anterior resection (LAR), with outcomes assessed through bowel function and quality of life metrics. The review identified six studies that met our eligibility criteria; a pooled cohort of 794 patients was identified, with sample sizes ranging from 37 to 430 participants. Our analysis revealed that pelvic floor rehabilitation significantly improves bowel function and quality of life in patients with LARS; yet, the optimal management approach remains unclear due to variability in patient responses. These findings highlight the inherent complexity and heterogeneity of LARS management, underscoring the necessity for multifaceted and individualized treatment strategies. Although pelvic floor rehabilitation shows promise, especially among motivated patients, its long-term sustainability remains uncertain. Surgical options are typically reserved for severe cases and carry significant risks and psychological impacts. For patients identified as being at high risk for LARS, treatment options must be considered and discussed at an earlier phase of their care. Our review concludes with the need for a tailored, patient-centered approach to managing LARS, highlighting the importance of ongoing research to fill existing evidence gaps. There is a need for translational research across various treatment modalities, comparing their effects, cost-effectiveness, implementation strategies, and the consequent effects on patients' quality of life and mental health. Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Ansar et al.)
Databáze:	MEDLINE
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