Managing Low Anterior Resection Syndrome and Optimizing Quality of Life following Rectal surgery
Notice bibliographique
Résumé
Introductions: Low Anterior Resection Syndrome (LARS), the bowel dysfunction that results from rectal surgery, has been correlated with a decrease in long-term quality of life (QoL) for rectal cancer survivors. Its current treatment options are limited. Transanal irrigation (TAI) is a non-surgical therapy which can be offered to patients whose LARS symptoms persist despite conservative measures. This thesis presents a systemic review of the evidence for the use of TAI to manage LARS and subsequently proposes a protocol for a cross-over randomized controlled trial (RCT) to address gaps in the current evidence.Methods: A systematic review of the medical literature on adults who use TAI to manage the bowel dysfunction that follows rectal surgery was conducted. The search was exhaustive, including four major medical databases, grey literature and national clinical registries. All relevant studies were included, apart from single case reports and case series containing less than 10 participants. The primary outcome of interest was the impact of TAI on bowel dysfunction, and secondary outcomes include any change in QoL, side effects, complications, and participant satisfaction with the therapy. Results were reported qualitatively due to the lack of single common outcome measure. Given the lack of high-quality evidence for the use of TAI, we designed a cross-over RCT to investigate the impact of TAI on QoL, as measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30), and bowel dysfunction, as measured by the LARS score and the Cleveland Clinic Fecal Incontinence Score (CCFIS), as well as patient satisfaction with TAI.Results: The review identified 9 studies and 3 abstracts which addressed use of TAI for the management of LARS. A total of 290 participants were included from across these trials, with a median of 18 participants per trial. The irrigations were performed in most trials using one of two commercially available kits with a cone or balloon catheter on a daily basis or every other day, with a volume starting at 1 liter and adjusted to individual participants’ tolerance. A change in LARS score was reported in six trials, all demonstrating a significant improvement in the score. The remaining studies used various bowel function scoring systems or measures of patient satisfaction. The outcome of the subjective measures of satisfaction were more variable with 40 to 100% of participants reporting success with TAI. QoL measures were reported in four trials with inconsistent findings, but all reported improvement in various individual domains, as measured by different scoring systems. All observational studies were at serious risk of bias, and the single RCT was of suboptimal quality. No meta-analysis was possible due to the lack of a common outcome measure and heterogeneity in the studies. The purposed RCT detailed in the thesis will address the lack of high-quality evidence for the use of TAI in LARS. It is a multi-center trial which aims to recruit 66 adult participants who have undergone a rectal resection and have persistent major or minor LARS despite conservative measures at least 6 months after their surgery. Participants will be randomized to either 3 months of irrigation, 1 month washout out and then 3 months of control with their current treatment, or the reverse. The impact of TAI will be assessed using patient centered outcome measures, through both qualitative and quantitative questionnaires. Conclusions: TAI is a promising potential treatment for LARS, but there are significant limitations in the current literature identified in this systematic review and further investigation is warranted as detailed in the accompanying RCT protocol
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».