Post anterior rectal resection syndrome – a retrospective multicentre study

Abstract

The long-term effects of surgical and non-surgical factors on increased stool frequency and incontinence following anterior resection have been variably reported. We investigated the effects of surgical characteristics on symptoms at 1 month and more than 1 year postoperatively following anterior resection of the rectum. In this retrospective study of patients who underwent anterior resection of the rectum during 2002-2006, patients were interviewed regarding symptoms at 1 month and more than 1 year postoperatively. Anterior resection of the rectum syndrome (ARRS) is more simply defined as incontinence and/or frequent bowel movements after surgery and graded as severe, moderate or mild. Of the 165 patients who underwent anterior resection for rectal cancer during the study period, 106 were included in the analysis. The median follow-up period was 3.4 years (range 13-72 months). ARRS had a high prevalence 1 month postoperatively (55.6%) but abated in over half the cases at 1 year postoperatively. The likelihood of development of early but not late ARRS was associated with the anastomotic level suggesting adaptation. ARRS and continence were unaffected by total mesorectal excision, the use of adjuvant radiation or chemotherapy, patient age or disease stage. The level of anastomosis in anterior resection of the rectum had a significant effect on the prevalence of ARRS using a new simpler definition 1 month after surgery but not 1 year or more postoperatively. Further data on neorectal reservoir reconstruction using the simpler ARRS definition are required.