Managing Low Anterior Resection Syndrome and Optimizing Quality of Life following Rectal surgery
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".