Evaluation of the Low Anterior Resection Syndrome and Quality of Life in Patients Having Undergone Sphincter Sparing Rectal Cancer Surgery

Abstract

Abstract Background In order to avoid abdomino-perineal amputation and permanent colostomy in patients with low rectal cancer sphincter sparing low anterior resection (SSLAR) techniques with/without neoadjuvant radio-chemotherapy are administered. However, a lot of SSLAR-patients have life quality limiting symptoms afterwards, like fecal urgency, incontinence, constipation and sensation of incomplete rectal emptying. Such symptoms are defined as “low anterior resection syndrome” (LARS). LARS quantification can be made by a specific and validated quality of life (QoL) questionnaire (see annex). Aims Assessment of the QoL in patients after SSLAR suffering from LARS before and after specific therapy. Methods This is a monocentric, retrospective cohort study including patients having undergone SSLAR for rectal cancer 2014 - 2021. Initial LARS-scores were obtained by completion of the specific questionnaire. Patients with a minor LARS (scores 21-29) were treated with electrostimulation and bio-feedback physiotherapy. Those with a major LARS (scores >29) were first investigated by anal manometry followed by physiotherapy. After treatment LARS-scores were obtained again. Results Of 136 identified SSLAR-patients, 68 did not fulfill the inclusion criteria’s (see annex). Of the remaining 54 patients, 20.4% had a minor, 37% a major and 42.6% no LARS. Of all LARS-patients, 13 completed pelvic physiotherapy, 4 are still completing and 14 (26%) refused such a treatment. The mean-LARS score was 32.77 and 22.92, before and after treatment, respectively (p=0.004). Risk factor analysis (diabetes, type of anastomosis, neoadjuvant radio-chemotherapy, previous operations, nicotine, alcohol) did not reveal any significant difference between groups. Conclusion More than 50% of patients undergoing SSLAR are suffering from LARS, more than one third from major LARS. QoL is impressively improved by specific physiotherapeutic measures. In order to avoid later treatment hesitancy (26%), we began to initiate early specific physiotherapy as a standard in all SSLAR-patients.