Assessment of Functional Outcome after Ultra-Low Anterior Resection as a Surgical Treatment of Low Rectal Carcinoma

Abstract

Background: In the treatment of distal rectal cancer, abdominoperineal resection (APR) has long been the only surgical option. However, the evolution of better surgical techniques, better understanding of locoregional tumor spreading, and the introduction of preoperative chemoradiotherapy have led to more sphincter-saving surgery. Since the day of the first description of this surgical procedure, various institutions have published their experience with this technique. Objective: The objective of the study was to assess the functional outcome after ultralow anterior resection as a surgical treatment of low rectal carcinoma. Method: An observational study was conducted from April 2018 to September 2019 among 17 patients with low rectal carcinoma who underwent ultralow anterior resection with or without chemo-radiotherapy. The study was carried out in the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University. Functional outcomes were measured at the 3rd, 6th, and 12th months of stoma closure by low anterior resection syndrome score, Wexner’s incontinence score, and Global health status and Functional scales of the European Organization for Treatment and Research of Cancer questionnaire. Results: LARS impact gradually decreases over time after stoma closure, from 3rd month to 6th month (p<0.001) and 12th month (p<0.001). The number of patients (88.2%) with Major LARS in the 3rd month decreases to 64.7% in the 6th month and 47.1% in the 12th month. A significant number of patients (41.2%) at the end of the 12th month had no LARS. The severity of incontinence also significantly decreases on follow-up (p<0.05, at 6th and 12th month). 23.5% of patients in the 3rd month had severe incontinence which improved and was evident only among 5.9% in the 6th month and none in the 12th month. Significant improvement was observed both in the 6th month and 12th month compared to the 3rd month in Global Health Status (58.11±9.51, 62.12±9.71, 69.27±10.61 ........