Low Anterior Resection Syndrome and Quality of Life After Sphincter-Sparing Rectal Cancer Surgery: A Long-term Longitudinal Follow-up

Abstract

BACKGROUND: Despite low anterior resection syndrome being a well-known consequence of sphincter-preserving rectal cancer surgery, the long-term effect on bowel function and quality of life is not fully understood. OBJECTIVE: This study aimed to elucidate whether symptoms of low anterior resection syndrome change over time and if the correlation to quality of life is equivalent when measured at 2 time points. DESIGN: This prospective cohort study included measurements at 2 time points (5 years between; range, 7.1–16.1 years from surgery to second follow-up). SETTINGS: This multicenter study included patients from Sweden and Denmark. PATIENTS: Patients were included if they were ≥18 years of age and underwent curative rectal cancer surgery with either total or partial mesorectal excision. MAIN OUTCOME MEASURES: Outcomes were measured with the low anterior resection syndrome questionnaire including a question assessing the impact of bowel function on quality of life and with the validated quality-of-life questionnaire EORTC QLQ-C30. RESULTS: In total, 282 patients were included and there were no statistically significant differences in the distribution among the 3 groups (no, minor, and major low anterior resection syndrome) when comparing time points follow-up 1 with follow-up 2 (p = 0.455). At follow-up 2, 138 patients (49%) still experienced major impairment. No both statistically and clinically significant differences were seen in the mean score of EORTC QLQ-C30 when comparing the same low anterior resection syndrome group at follow-up 1 and follow-up 2, and the impact on quality of life was comparable. Global health status/quality of life was impaired in the major low anterior resection syndrome group at both follow-up 1 (p < 0.001) and follow-up 2 (p < 0.001). LIMITATIONS: The study design prevents an evaluation of causality. CONCLUSIONS: Difficulties with low anterior resection syndrome and the impact on patients’ quality of life persist over time. See Video Abstract at http://links.lww.com/DCR/A762.

Long-term bowel dysfunction following low anterior resection

“…Differently from our study, Gadan et al did show the long-term negative effect of ileostomy formation on bowel function 13 . Similarly to our study, Pienowski et al found in a long-term preoperative chemoradiotherapy, younger age and low level of the tumour were the risk factors of having LARS, and having major LARS 14 .…”

“…To our knowledge there are only five studies investigating long-term LARS following rectal surgery and influence it has on patients’ daily life using validated LARS score 10 – 14 . These studies showed that LARS was found in 47.5% to 90% of patients following rectal cancer surgery in long-term period.…”

‘French LARS score’: validation of the French version of the low anterior resection syndrome (LARS) score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients: a study protocol

“…These recent studies have indicated that there is a need for improved LARS education for clinicians 25 26. There is now evidence that both the distribution of patients within different LARS groups (minor and/or major) and the impact of LARS on QoL do not change over time 30. According to recent studies,31 nearly 50% of patients still experience major LARS 13 to 15 years after surgery.…”

A randomized trial comparing transanal irrigation and percutaneous tibial nerve stimulation in the management of low anterior resection syndrome

“…Sphincter preservation and restoration of intestinal continuity is feasible in up to 80% of patients with rectal cancer, thereby avoiding a stoma. Nonetheless, 60–70% of patients will experience a more or less permanent set or combination of symptoms, collectively known as low anterior resection syndrome (LARS), that range from faecal incontinence to intestinal dysfunction in the form of erratic defaecatory patterns, faecal urgency and obstructed defaecation . This syndrome has a negative impact on quality of life and patients become toilet dependent .…”