Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment.
Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment.
复制标题
DOI：
10.3390/cancers15205011
复制
发表时间：
2023-10-16
期刊：
影响因子：
5.2
通讯作者：
Li, Xinxiang
中科院分区：
文献类型：
--
作者：
Zhang, Ruijia;Luo, Wenqin;Qiu, Yulin;Chen, Fan;Luo, Dakui;Yang, Yufei;He, Weijing;Li, Qingguo;Li, Xinxiang
低前切除术综合征（LARS）显著影响80%接受保留括约肌手术患者的生活，通常导致生活质量下降和社交回避。然而，缺乏系统的标准和多样的测量和治疗方法阻碍了对LARS的最佳管理和理解。本研究旨在综合到2023年的研究结果，建立统一的诊断标准和管理方案，以促进特定临床试验结果与临床应用的无缝整合。目的是使研究结果具有可比性，并加强临床方法，可能提供一个连贯的框架，以形成未来的研究方向，并改善LARS管理的临床结果。我们建议在临床治疗中，应使用至少一份症状评估问卷和一份与生活质量相关的量表来评估LARS的严重程度。在临床试验中，根据本研究建议采用包括LARS评分、EORTC QLQC30、肛肠测压在内的新标准。为LARS的规范化临床管理建立逐步分类模型。背景：前低位切除综合征（LARS）是一系列肠功能障碍症状，包括排便频率改变、排便节律不规则、大便失禁和便秘。LARS发生在80%接受保留括约肌手术的患者中，影响患者的生活质量并伴有社交回避。人们提出了不同的测量方法和处理方法来处理LARS，但尚未形成系统的标准。目的与方法：为了促进LARS临床试验和临床管理的规范化，本文综述了截至2023年直肠癌术后LARS的诊断标准、评估方案和治疗方式的最新研究进展。结果：LARS的诊断标准需要更新到LARS国际协作组提出的定义，取代目前应用的LARS评分。在临床试验和临床治疗中，应使用至少一份症状评估问卷、LARS评分或MSKCC BFI以及至少一份与生活质量相关的量表来评估LARS的严重程度。建议仅在临床试验中采用肛门直肠测压、流量测定、超声内镜检查和盆底肌力测试。通过对LARS治疗最新文献的分析，建立了LARS临床规范化管理的逐步分类模型。轻度LARS患者可以从一线治疗开始，包括以饮食调整和药物治疗为重点的自我行为管理。拉莫司琼、盐酸科尔西韦仑和洛哌丁胺是常见的止泻药。二线治疗是多模式盆底康复和经肛冲洗。严重LARS患者在二线治疗中应选择单一或多种治疗。顽固性LARS可选择顺行灌肠、神经调节或结肠造口术。结论：在2020 - 2022年LARS治疗的临床试验中，资格标准和评价体系有所不同。因此，迫切需要制定LARS的诊断、评估和治疗标准。未能设置安慰剂和区分亚组是当前许多LARS研究的局限性。也没有比较不同疗法和长期结果的随机对照试验。此外，需要开发一种新的量表，以纳入患者的观点，方便门诊随访。虽然建立LARS治疗的逐步分类模型是必不可少的，但通过更规范的研究可以改进指南的完善。
Low anterior resection syndrome (LARS) significantly impacts the lives of 80% of patients who undergo sphincter-preserving surgery, often leading to diminished quality of life and social avoidance. However, a lack of systematic standards and varied measurement and treatment approaches have hindered optimal management and understanding of LARS. This study seeks to synthesize findings from up until 2023 and establish unified diagnostic criteria and management protocols to facilitate seamless integration of findings from specifical clinical trials into clinical application. The aim is to enable comparable research outcomes and enhance clinical methodologies, potentially offering a coherent framework that could shape future research directions and improve clinical outcomes in LARS management. We proposed that in clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire and one scale related to quality of life. In clinical trials, a new criterion including the LARS score, EORTC QLQC30, and anorectal manometry is suggested to be adopted by following the research. A stepwise classification model was set up for the standardized clinical management of LARS. Background: Low anterior resection syndrome (LARS) is a series of bowel dysfunction symptoms, including altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation. LARS occurs in 80% of patients undergoing sphincter-preserving surgery, affecting patients’ quality of life along with social avoidance. Different measurements and treatments have been raised to deal with LARS, but no systematic standard has been developed. Objective and Methods: To promote the standardization of clinical trials and clinical management of LARS, this review summarizes the latest findings up until 2023 regarding the diagnostic criteria, assessment protocols, and treatment modalities for postoperative LARS in rectal cancer. Results: The diagnostic criteria for LARS need to be updated to the definition proposed by the LARS International Collaborative Group, replacing the current application of the LARS score. In both clinical trials and clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire, the LARS score or MSKCC BFI, and at least one scale related to quality of life. Anorectal manometry, fecoflowmetry, endoscopic ultrasonography, and pelvic floor muscle strength testing are recommended to be adopted only in clinical trials. After analysis of the latest literature on LARS treatment, a stepwise classification model is established for the standardized clinical management of LARS. Patients with minor LARS can start with first-line treatment, including management of self-behavior with an emphasis on diet modification and medication. Lamosetron, colesevelam hydrochloride, and loperamide are common antidiarrheal agents. Second-line management indicates multi-mode pelvic floor rehabilitation and transanal irrigation. Patients with major LARS should select single or several treatments in second-line management. Refractory LARS can choose antegrade enema, neuromodulation, or colostomy. Conclusions: In clinical trials of LARS treatment between 2020 and 2022, the eligibility criteria and evaluation system have been variable. Therefore, it is urgent to create a standard for the diagnosis, assessment, and treatment of LARS. Failure to set placebos and differentiate subgroups are limitations of many current LARS studies. Randomized controlled trials comparing diverse therapies and long-term outcomes are absent, as well. Moreover, a new scale needs to be developed to incorporate the patient’s perspective and facilitate outpatient follow-up. Though the establishment of a stepwise classification model for LARS treatment here is indispensable, the refinement of the guidelines may be improved by more standardized studies.
登录
查看更多内容
影响因子：
3.4
作者：
Dalsgaard, Peter;Emmertsen, Katrine Jossing;Christensen, Peter
通讯作者：
Christensen, Peter
影响因子：
3.9
作者：
Didailler, Romain;Denost, Quentin;Rullier, Eric
通讯作者：
Rullier, Eric
影响因子：
3.9
作者：
Dilke, Stella M.;Hadjittofi, Christopher;Stearns, Adam T.
通讯作者：
Stearns, Adam T.
DOI：
10.17116/kurort20209705152
发表时间：
2020-01-01
影响因子：
--
作者：
Fomenko, O Yu;Kashnikov, V N;Nafedzov, I O
通讯作者：
Nafedzov, I O
DOI：
10.14309/ajg.0000000000001069
发表时间：
2021-01-01
期刊：
The American journal of gastroenterology
影响因子：
--
作者：
Bharucha AE;Oblizajek NR
通讯作者：
Oblizajek NR