The EORTC QLQ-C30 and QLQ-CR29 may play a complementary role to LARS score in evaluating the quality of life for patients following laparoscopic and robotic rectal cancer surgery

Objective:To analyze whether the European Organisation for Treatment and Research of Cancer(EORTC)Quality of Life Questionnaires(QLQ-C30 and QLQ-CR29)complement the low anterior resection of rectum syndrome(LARS)score in evaluating the quality of life of patients who underwent laparoscopic or robotic rectal cancer surgery.Methods:Initially,335 patients who underwent laparoscopic or robotic rectal cancer surgery were randomly selected at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from June 2013 to September 2020.All the patients took the questionnaires of LARS score,QLQ-C30 and QLQ-CR29.Totally,questionnaires filled out by 224 patients were qualified after screening.Patients were divided into three groups according to LARS score:No LARS group(score 0-20),minor LARS group(score 21-29)and major LARS group(score 30-42).The scores of QLQ-C30 as well as QLQ-CR29 among the three groups were compared.Results:Major,minor and no LARS groups had 140 cases,40 cases and 44 cases respectively.In the scales of QLQ-C30,significant differences were discovered in global quality of life,physical function,role function,emotional function,cognitive function,social function,fatigue,pain,dyspnea,sleep disturbance,constipation and diarrhea between the no and major LARS groups(p<0.05).While the differences were only found in global quality of life and diarrhea between the minor and major LARS groups(p<0.05).In QLQ-CR29,scales of urinary frequency,blood and mucus in stool,body image,flatulence,fecal incontinence,sore skin,stool frequency,embarrassment,impotence,abdominal pain,buttock pain,bloating,dry mouth,hair loss,taste,anxiety and weight,had significant differences between the no and major LARS groups(p<0.05).Only six scales,ie blood and mucus in stool,flatulence,fecal incontinence,stool frequency,embarrassment and dysuria had significant differences between the minor and major LARS groups(p<0.05).Conclusion:For patients following laparoscopic or robotic low anal sphincter preserving surgery,LARS score,QLQ-C30 and QLQ-CR29 scores are consistent in overall trends.To guide disease evaluation and individualized treatment,as well as to evaluate efficacy,we suggest getting pre-and post-operative LARS scores incorporating QLQ-C30 and QLQ-CR29 scores as a comprehensive evaluation system.

Risk factors for incomplete polyp resection during colonoscopy

Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.