Correlation of Two Different Bowel Dysfunction Questioneria on the Psychological State of the Rectal Cancer Patients

Year 2023, , 671 - 677, 30.12.2023

Sami Benli , Deniz Tazeoğlu , Alper Zıblak , Tahsin Çolak

https://doi.org/10.18663/tjcl.1317421

Abstract

Aim: Most patients have impaired bowel function after sphincter-sparing surgery (SPS) combined with total mesorectal excision (TME). This study evaluated bowel dysfunction's effect on a patient's psychological state using the LARS Questionnaire (LARS-Q) and the Memorial Sloan Kettering Bowel Function Instrument (MSK-BFI).
Material and Methods: Between June 2019 and June 2022, 127 patients operated on for rectal cancer with TME and SPS were examined regarding bowel dysfunction in the sixth postoperative month. The LARS score and MSK-BFI assessed bowel function. Beck anxiety inventory (BAI), Beck depression inventory (BDI), and Beck hopelessness inventory (BHI) were also applied to the patients. The correlation of LARS-Q and MSK-BFI questionnaire scores was examined with each other and the other three questionnaire scores.
Results: Major LARS was seen in 29.9% of the patients. MSK-BFI scores were found to be 60. The median MSK-BFI scores for no LARS, minor LARS, and major LARS were 77, 68, and 52, respectively. Strong correlations were found between MSK-BFI and LARS-Q (rs -0.63). When the correlation between LARS-Q and BAI, BDI, and BHI was evaluated, rs 0.38, rs 0.49, and rs 0.56 were found, respectively. When the correlation between MSK-BFI and BAI, BDI, and BHI was evaluated, rs -0.67, -0.71, and -0.74 were found, respectively.
Conclusion: Bowel dysfunction is a prevalent condition after sphincter-sparing rectal cancer surgery. Impaired sphincter functions significantly affect patients' social and emotional aspects and negatively affect their quality of life.

Keywords

Anorectal function, MSK-BFI, LARS-Q, bowel dysfunction, low anterior resection syndrome.

İki Farklı Bağırsak Disfonksiyonu Anketinin Rektal Kanser Hastalarının Psikolojik Durumu Üzerindeki Korelasyonu

Abstract

Amaç: Sfinkter koruyucu cerrahi ile birlikte total mezorektal eksizyon (TME) sonrasında hastaların çoğunda barsak fonksiyonları bozulur. Bu çalışma, LARS Anketi (LARS-Q) ve Memorial Sloan Kettering Bağırsak Fonksiyonu Ölçeği (MSK-BFI) kullanılarak bağırsak disfonksiyonunun hastanın psikolojik durumu üzerindeki etkisini değerlendirmeyi amaçladı.
Gereç ve Yöntemler: Haziran 2019-Haziran 2022 tarihleri arasında rektum kanseri nedeniyle TME ve SPS ile opere edilen 127 hasta postoperatif 6. ayda barsak disfonksiyonu açısından incelendi. LARS skoru ve MSK-BFI bağırsak fonksiyonunu değerlendirdi. Hastalara Beck anksiyete envanteri (BAI), Beck depresyon envanteri (BDI) ve Beck umutsuzluk envanteri (BHI) de uygulandı. LARS-Q ve MSK-BFI anket puanlarının birbirleriyle ve diğer üç anket puanları ile korelasyonu incelenmiştir.
Bulgular: Majör LARS hastaların %29.9'unda görüldü. MSK-BFI skorları 60 bulundu. LARS olmayan, minör LARS ve majör LARS için ortanca MSK-BFI skorları sırasıyla 77, 68 ve 52 idi. MSK-BFI ve LARS-Q arasında güçlü korelasyonlar bulundu (rs -0.63). LARS-Q ile BAI, BDI ve BHI arasındaki korelasyon değerlendirildiğinde sırasıyla rs 0.38, rs 0.49 ve rs 0.56 bulundu. MSK-BFI ile BAI, BDI ve BHI arasındaki korelasyon değerlendirildiğinde sırasıyla rs -0,67, -0,71 ve -0,74 bulundu.
Sonuç: Sfinkter koruyucu rektal kanser cerrahisi sonrası barsak disfonksiyonu sık görülen bir durumdur. Bozulmuş sfinkter fonksiyonları hastaların sosyal ve emosyonel yönlerini önemli ölçüde etkilemekte ve yaşam kalitelerini olumsuz etkilemektedir.

Keywords

Anorektal fonksiyon, MSK-BFI, LARS-Q, bağırsak fonksiyon bozukluğu, low anterior rezeksiyon sendromu.

References

• Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740. https://doi.org/10.1056/NEJMoa040694
• Keane C, Fearnhead NS, Bordeianou LG, Christensen P, Basany EE, Laurberg S, et al. International consensus definition of low anterior resection syndrome. Dis Colon Rectum 2020; 63: 274–84.
• Battersby NJ, Juul T, Christensen P et al (2016) Predicting the risk of bowel-related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis Colon Rectum 59:270–280. https://doi.org/10.1097/DCR.0000000000000552
• Bryant CL, Lunniss PJ, Knowles CH et al (2012) Anterior resection syndrome. Lancet Oncol 13:e403–e408. https://doi.org/10.1016/S1470-2045(12)70236-X
• Ribas Y, Aguilar F, Jovell-Fernandez E, Cayetano L, Navarro-Luna A, Munoz-Duyos A (2017) Clinical application of the LARS score: results from a pilot study. Int J Colorectal Dis 32:409–418. https://doi.org/10.1007/s00384-016-2690-7
• Yolanda Ribas , Montse Martín-Baranera , Ladislao Cayetano , Carles Maristany , Josep Bargalló , Salvadora Delgado, Arantxa Muñoz-Duyos. Prospective evaluation of bowel dysfunction after rectal cancer surgery. Support Care Cancer. 2022 Jul;30(7):5939-5947. doi: 10.1007/s00520-022-07030-5. Epub 2022 Apr 7.
• Scheer AS, Boushey RP, Liang S, Doucette S, O’Connor AM, Moher D (2011) The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 54:1589–1597
• Chen TY, Emmertsen KJ, Laurberg S (2015) What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Curr Colorectal Cancer Rep 11:37–43
• Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 2012; 255: 922–8.
• Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 2005; 48: 1353–65.
• Felipe F Quezada-Diaz , Hossam Elfeki , Katrine J Emmertsen , Emmanouil P Pappou , Rosa Jimenez-Rodriguez , Sujata Patil , Søren Laurberg , Julio Garcia-Aguilar . Comparative analysis of the Memorial Sloan Kettering Bowel Function Instrument and the Low Anterior Resection Syndrome Questionnaire for assessment of bowel dysfunction in rectal cancer patients after low anterior resection. Colorectal Dis. 2021 Feb;23(2):451-460. doi: 10.1111/codi.15515. Epub 2021 Feb 10.
• Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 2012; 255: 922–8.
• Quezada-Diaz FF, Elfeki H, Emmertsen KJ, Pappou EP, Jimenez-Rodriguez R, Patil S, Laurberg S, Garcia-Aguilar J. Comparative analysis of the Memorial Sloan Kettering Bowel Function Instrument and the Low Anterior Resection Syndrome Questionnaire for assessment of bowel dysfunction in rectal cancer patients after low anterior resection. Colorectal Dis. 2021 Feb;23(2):451-460. doi: 10.1111/codi.15515. Epub 2021 Feb 10. PMID: 33405307; PMCID: PMC8023229.
• Croese AD, Lonie JM, Trollope AF et al (2018) A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors. Int J Surg 56:234–241. https://doi.org/10.1016/j.ijsu.2018.06.031
• Yolanda Ribas , Montse Martín-Baranera , Ladislao Cayetano , Carles Maristany , Josep Bargalló , Salvadora Delgado , Arantxa Muñoz-Duyos . Prospective evaluation of bowel dysfunction after rectal cancer surgery. Support Care Cancer. 2022 Jul;30(7):5939-5947. doi: 10.1007/s00520-022-07030-5. Epub 2022 Apr 7.
• Felipe F Quezada-Diaz , Hossam Elfeki , Katrine J Emmertsen , Emmanouil P Pappou , Rosa Jimenez-Rodriguez , Sujata Patil , Søren Laurberg , Julio Garcia-Aguilar . Comparative analysis of the Memorial Sloan Kettering Bowel Function Instrument and the Low Anterior Resection Syndrome Questionnaire for assessment of bowel dysfunction in rectal cancer patients after low anterior resection. Colorectal Dis. 2021 Feb;23(2):451-460. doi: 10.1111/codi.15515. Epub 2021 Feb 10.
• Koda K, Yamazaki M, Shuto K, Kosugi C, Mori M, Narushima K, et al.. Etiology and management of low anterior resection syndrome based on the normal defecation mechanism. Surg Today (2019) 49:803–8. doi: 10.1007/s00595-019-01795-9.
• Smith JJ, Strombom P, Chow OS, Roxburgh CS, Lynn P, Eaton A, et al.. Assessment of a watch-and-Wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy. JAMA Oncol (2019) 5:e185896. doi: 10.1001/jamaoncol.2018.5896
• Youn Young Park , Seung Yoon Yang , Yoon Dae Han , Min Soo Cho , Hyuk Hur , Byung Soh Min , Kang Young Lee , Nam Kyu Kim . Predictive Factors for Bowel Dysfunction After Sphincter-Preserving Surgery for Rectal Cancer: A Single-Center Cross-sectional Study. Dis Colon Rectum. 2019 Aug;62(8):925-933.doi: 10.1097/DCR.0000000000001374.
• Nick J Battersby , Therese Juul, Peter Christensen, Ahmed Z Janjua, Graham Branagan, Katrine J Emmertsen, Christine Norton, Robert Hughes, Søren Laurberg, Brendan J Moran, United Kingdom Low Anterior Resection Syndrome Study Group. Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study. Dis Colon Rectum. 2016 Apr;59(4):270-80. doi:10.1097/DCR.0000000000000552.
• Therese Juul , Madelene Ahlberg, Sebastiano Biondo, Eloy Espin, Luis Miguel Jimenez, Klaus E Matzel, Gabriella Jansson Palmer, Anna Sauermann, Loris Trenti, Wei Zhang, Søren Laurberg, Peter Christensen.Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum. 2014 May;57(5):585-91. doi: 10.1097/DCR.0000000000000116.
• F Al Rashid , A S Liberman , P Charlebois , B Stein , L S Feldman , J F Fiore Jr , L Lee. The impact of bowel dysfunction on health-related quality of life after rectal cancer surgery: a systematic review. Tech Coloproctol. 2022 Jul;26(7):515-527.doi: 10.1007/s10151-022-02594-0. Epub 2022 Mar 3.
• Kim MJ, Park JW, Lee MA, et al. Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life. Sci Rep. 2021;11(1):3538. Published 2021 Feb 11. doi:10.1038/s41598-021-82149-9
• Van Der Heijden, J., Thomas, G., Caers, F., van Dijk, W., Slooter, G., Maaskant-Braat, S.,2019. What you should know about the low anterior resection syndrome–clinical recommendations from a patient perspective. Eur J Surg Oncol. 2018 Sep;44(9):1331-1337.doi: 10.1016/j.ejso.2018.05.010. Epub 2018 May 16.