Annals of Coloproctology

Original Articles

Anorectal physioloy

Risk factors associated with low anterior resection syndrome: a cross-sectional study: See Liang Lim, Wan Zainira Wan Zain, Zalina Zahari, Andee Dzulkarnaen Zakaria, Mohd Nizam Md Hashim, Michael Pak-Kai Wong, Zaidi Zakaria, Rosnelifaizur Ramely, Ahmad Shanwani Mohamed Sidek; Ann Coloproctol. 2023;39(5):427-434. Published online June 3, 2022; DOI: https://doi.org/10.3393/ac.2022.00227.0032

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
Oncological outcomes following rectal cancer surgery have improved significantly over recent decades with lower recurrences and longer overall survival. However, many of the patients experienced low anterior resection syndrome (LARS). This study identified the prevalence and risk factors associated with the development of LARS.
Methods
This cross-sectional study involved patients who were diagnosed with rectal cancer and had undergone sphincter-preserving low anterior resection from January 2011 to December 2020. Upon clinic follow-up, patients were asked to complete an interviewed based questionnaire (LARS score) designed to assess bowel dysfunction after rectal cancer surgery.
Results
Out of 76 patients, 25 patients (32.9%) had major LARS, 10 patients (13.2%) had minor LARS, and 41 patients (53.9%) had no LARS. The height of tumor from anal verge showed an association with the development of major LARS (P=0.039). Those patients with less than 8 cm tumor from anal verge had an increased risk of LARS by 3 times compared to those with 8 cm and above (adjusted odds ratio, 3.11; 95% confidence interval, 1.06–9.13).
Conclusion
Results from our study show that low tumor height was a significant risk factor that has a negative impact on bowel function after surgery. The high prevalence of LARS emphasizes the need for study regarding risk factors and the importance of understanding the pathophysiology of LARS, in order for us to improve patient bowel function and quality of life after rectal cancer surgery.

Citations

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Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer
Hyeung-min Park, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
Low anterior resection syndrome: is it predictable?
Dong Hyun Kang
Annals of Coloproctology.2023; 39(5): 373. CrossRef

Variation in the Height of Rectal Cancers According to the Diagnostic Modalities: Seung-Seop Yeom, In Ja Park, Dong-Hoon Yang, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Sung Ho Park, Hwa Jung Kim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2019;35(1):24-29. Published online February 28, 2019; DOI: https://doi.org/10.3393/ac.2018.07.31

5,434 View
116 Download
11 Web of Science
11 Citations

Abstract PDF

Purpose
Although the height of a rectal tumor above the anal verge (tumor height) partly determines the treatment strategy, no practical standard exists for reporting this. We aimed to demonstrate the differences in tumor height according to the diagnostic modality used for its measurement.
Methods
We identified 100 patients with rectal cancers located within 15 cm of the anal verge who had recorded tumor heights measured by using magnetic resonance imaging (MRI), colonoscopy, and digital rectal examination (DRE). Tumor height measured by using MRI was compared with those measured by using DRE and colonoscopy to assess reporting inconsistencies. Factors associated with differences in tumor height among the modalities were also evaluated.
Results
The mean tumor heights were 77.8 ± 3.3, 52.9 ± 2.3, and 68.9 ± 3.1 mm when measured by using MRI, DRE, and colonoscopy, respectively (P < 0.001). Agreement among the 3 modalities in terms of tumor sublocation within the rectum was found in only 39% of the patients. In the univariate and the multivariate analyses, clinical stage showed a possible association with concordance among modalities, but age, sex, and luminal location of the tumor were not associated with differences among modalities.
Conclusion
The heights of rectal cancer differed according to the diagnostic modality. Tumor height has implications for rectal cancer’s surgical planning and for interpreting comparative studies. Hence, a consensus is needed for measuring and reporting tumor height.

Citations

Citations to this article as recorded by

The efficacy of open transanal drainage tube against anastomotic leakage in left-sided colorectal cancer surgery: a propensity score matching study
Gen Tsujio, Tatsunari Fukuoka, Atsushi Sugimoto, Ken Yonemitsu, Yuki Seki, Hiroaki Kasashima, Yuichiro Miki, Mami Yoshii, Tatsuro Tamura, Masatsune Shibutani, Takahiro Toyokawa, Shigeru Lee, Kiyoshi Maeda
BMC Surgery.2025;[Epub] CrossRef
Defining the tumor location in rectal cancer – Practice variations and impact on treatment decision making
Elisabeth P. Goedegebuure, Francesco M. Arico, Max J. Lahaye, Monique Maas, Geerard L. Beets, Femke P. Peters, Monique E. van Leerdam, Regina G.H. Beets-Tan, Doenja M.J. Lambregts
European Journal of Surgical Oncology.2025; 51(6): 109700. CrossRef
Effects of Adjuvant Chemotherapy on Oncologic Outcomes in Patients With Stage ⅡA Rectal Cancer Above the Peritoneal Reflection Who Did Not Undergo Preoperative Chemoradiotherapy
Hyo Seon Ryu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Yong Sang Hong, Tae Won Kim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(4): 392. CrossRef
Interrater Agreement of Height Assessment by Rigid Proctoscopy/Rectoscopy for Rectal Carcinoma
Matthias Kraemer, Sarkhan Nabiyev, Silvia Kraemer, Stephanie Schipmann
Diseases of the Colon & Rectum.2024; 67(8): 1018. CrossRef
Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer
Jingnan Li, Hongwei Yao, Yun Lu, Shutian Zhang, Zhongtao Zhang
Chinese Medical Journal.2024; 137(17): 2017. CrossRef
Review of definition and treatment of upper rectal cancer
Elias Karam, Fabien Fredon, Yassine Eid, Olivier Muller, Marie Besson, Nicolas Michot, Urs Giger-Pabst, Arnaud Alves, Mehdi Ouaissi
Surgical Oncology.2024; 57: 102145. CrossRef
Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer
Mohammed H. Basendowah, Mohammed A. Ezzat, Aseel H. Khayyat, Eyad Saleh A. Alamri, Turki A. Madani, Anas H. Alzahrani, Rana Y. Bokhary, Arwa O. Badeeb, Hussam A. Hijazi
Cancer Reports.2023;[Epub] CrossRef
Measuring Rectal Cancer Tumor Height: Concordance Between Clinical Examination and MRI
Shannon M. Navarro, Shuai Chen, Linda M. Farkas
Diseases of the Colon & Rectum.2022; 65(4): 497. CrossRef
How do they measure up: Assessing the height of rectal cancer with digital rectal exam, endoscopy, and MRI,,
Jordan Wlodarczyk, Kshitij Gaur, Nicholas Serniak, Kevin Mertz, Jason Muri, Sarah Koller, Sang W. Lee, Kyle G. Cologne
Surgery in Practice and Science.2022; 10: 100096. CrossRef
Measurement of rectal tumor height from the anal verge on MRI: a comparison of internal versus external anal sphincter
David D. B. Bates, James L. Fuqua, Junting Zheng, Marinela Capanu, Jennifer S. Golia Pernicka, Sidra Javed-Tayyab, Viktoriya Paroder, Iva Petkovska, Marc J. Gollub
Abdominal Radiology.2021; 46(3): 867. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef

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