الفهرس 
Anatomy of RectumOnly 14 pages are availabe for public view
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Abstract
Rectal Cancer is the third most cancer and the second leading cause of cancer related deaths in the western world. It occurs due to abnormal growth of the lining cells of the rectum that have the ability to invade and spread to other parts of the body. Surgery is the only curative therapy for rectal cancer. However, functional disturbances may follow thus constitutes a major problem for many surviving rectal cancer patients following a sphincter saving procedure with symptoms ranging from daily episodes of incontinence to obstructed defecation, constipation & low ant resection syndrome (LARS).
-This study aimed to:
assess the anterior resection syndrome in patients with rectal cancer who underwent low anterior resection as regards incidence, timing, effect on quality of life & its fate or improvement.
-Methods:
The current retrospective observational study was conducted among low rectal cancer patients who underwent low anterior resection at Tanta cancer center (TCC) between January 2015 - January 2017.
Fifty two patients were interviewed by a standard LARS score questionnaire at four points of follow up (1 month, 6 months, 12 months and 24 months). Each patient answered four questionnaires. Scores were calculated and compared between the four points of follow up. Data analysis was done using SPSS 24 and significant results were considered at P-value less than 0.05
-Results:
Patients` mean age was 51.1 years old (± 9.6) and it ranged from 34 to 76 years. The highest age-group in this study was 40 – 49 years age-group, followed by the 50 – 59 years age-group. The study included 35 male patients (67.3%) and 17 female patients (32.7%). Despite female patients were older than male patients, this difference in the mean age between male and female patients was not statistically significant. Regarding patients’ responses to the different LARS questionnaire at the four time points of follow-up period (1 month, 6 months, 12 months, and 24 months); there was a statistically significant decrease in the percentage of patients who cannot control their flatus from one-month (53.8%) to 24-month (36.5%) follow-up time. There was no significant change in the percentage of patients who had any accidental liquid stool leakage. However, there was a notable decrease in the percentage of those patients from 69.2% at one-month to 59.6% at 24-month follow-up time. Although there was a notable increase in the frequency of bowel habits among patients over the follow-up period, this change in the bowel habit was not statistically significant. There is a statistically significant decrease in the percentage of patients who experience a bowel opening within one-hour of the last act (from 46.2% at one-month to 30.8% at 24-month follow-up time). There was a statistically significant decrease in the percentage of patients who experience a strong urge to open their bowel that they have rush to the toilet (from 50% at one-month to 34.6% at 24-month follow-up time). Regarding the average LARS score, the change in the average score at each time point during the follow-up period. The average overall LARS score showed a gradual and statistically significant decrease over the 24-month follow-up period (from 30.92 to 27.04). The major decline occurred from the 6-month to the 12-month scores. Among male patients, the average LARS score showed a similar significant decrease from 31.91 to 26.86. However, female patients did not show significant change in their LARS score over the follow-up time. there is a statistically significant decrease in the severity of LARS status (i.e. decrease in the percentage of patients with major LARS and increase in the percentage of patients with minor or no LARS) across the different follow-up time points. However, this notable change in LARS status across time points was not statistically significant.
There were a direct moderate correlation between age and LARS scores at different time points. However, these direct correlations were not statistically significant except at 6-month time point (p-value = 0.044). Moreover, intuitively, the LARS scores at each time point show a significant direct and robust correlation with LARS scores at other time points (p-value < 0.001).
- Conclusions and recommendations:
Rectal surgeries contributed to increase of survival rates of rectal
cancer patients yet bowel dysfunctions may result thus affects the quality of life of rectal cancer survivors. Therefore it is important that clinicians and researchers focus on this syndrome to improve the prevention and the treatment of bowel dysfunction and the information given to patients. LARS is an important consequence that affects a large number of rectal cancer survivors . However, it is reported that the severity of LARS decrease with time for these patients.