Abstract
To identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504–43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504–43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100–4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.
Highlights
Rectal cancer survival rates have markedly improved as a result of advances in surveillance, surgery, and chemoradiotherapy
Our study found that preoperative radiotherapy, low rectal cancer, and postoperative complications were independent risk factors for major low anterior resection syndrome (LARS)
LARS was classified into incontinence- and frequency-dominant patterns, with each pattern being related to different risk factors
Summary
Rectal cancer survival rates have markedly improved as a result of advances in surveillance, surgery, and chemoradiotherapy. The evaluation of LARS varies considerably between studies, and the majority of previous studies focused on incontinence, rather than on other symptoms, such as frequency, clustering, incomplete emptying, and QOL. To overcome these limitations, the following two questionnaires were developed to assess LARS symptoms: Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC BFI) and LARS s core[6,7]. This study aimed to evaluate LARS risk factors using data gathered from patients undergoing long-term follow-up after rectal cancer surgery, and to identify patterns associated with LARS based on the major symptoms and their subsequent effects on QOL
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