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Functional outcome following rectal surgery—predisposing factors for low anterior resection syndrome

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Developments in surgical techniques and neoadjuvant treatment have enabled an increasing proportion of patients with rectal cancer to undergo sphincter-sparing resections. The avoidance of a permanent stoma can come at the cost of poor bowel function which can significantly impact patients’ quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal cancer surgery.

Methods

Patients undergoing anterior resection for rectal cancer between January 2009 and January 2015 were identified from a rectal cancer database at a single centre. All patients who had bowel continuity restored and underwent curative resection were sent a validated low anterior resection syndrome (LARS) questionnaire. Pre-, inter- and postoperative factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression.

Results

There was an 80% response rate (n = 68). Thirty-eight patients (56%) had major LARS symptoms. Neoadjuvant radiotherapy, predominantly long-course chemoradiotherapy (LCCRT), was an independent risk factor for development of major LARS symptoms, while restoration of bowel continuity within 6 months was protective.

Conclusions

The use of neoadjuvant radiotherapy (LCCRT) and timing of stoma reversal are risk factors for the development of severe bowel dysfunction. The potential for long-term poor functional results after LCCRT should be discussed with patients and form a part of the decision-making in individual treatment plans. The timing of the ileostomy closure, where safe and feasible, should be performed within 6 months to improve outcome.

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Acknowledgements

The authors thank the LARRIS (Low Anterior Resection and Rectal Irrigation Study) Trial Management Group: Cadogan J, Cornish JA, Davies Z, Edwards K, Hughes D, Keenan S, Lovell-Smith C, McCutchan G, Morris C, O’Neill C, Power K, Torkington J, Turner J and Williams C.

Author contribution

Each author named in this paper significantly contributed to the creation of this manuscript. D Hughes was involved with acquisition of data, analysis and interpretation of data. J Cornish was involved with the design creation of the study, data collection and subsequent analysis of the data. C Morris was involved with study design, data collection and statistical interpretation of gathered data. All three authors have read the final manuscript prior to submission.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK

    Daniel Ll Hughes & Chris Morris

  2. Department of Colorectal Surgery, Royal Glamorgan Hospital, Llantrisant, CF72 8XR, UK

    Julie Cornish

Authors
  1. Daniel Ll Hughes
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  2. Julie Cornish
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  3. Chris Morris
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Consortia

On behalf of the LARRIS Trial Management Group

Corresponding author

Correspondence to Julie Cornish.

Ethics declarations

Financial disclosures

This research was supported with a grant from Tenovus (Charity Number 1054015).

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

This study has been presented as an oral presentation by Daniel Hughes at the Welsh Surgical Society Autumn Meeting at the Morriston Hospital, Swansea, Wales, UK. Meeting dates are 26–27th of November 2015. The study has also been presented as a poster presentation at the Association of Coloproctology of Great Britain and Ireland Annual Meeting in Edinburgh, Scotland, UK. Conference dates are 4–6th July 2016.

Appendices

Appendix

On behalf of the LARRIS Trial Management Group

Cadogan J

Cornish JA

Davies Z

Edwards K

Hughes D

Keenan S

Lovell-Smith C

McCutchan G

Morris C

O’Neill C

Power K

Torkington J

Turner J

Williams C

Appendix LARS questionnaire

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Hughes, D.L., Cornish, J., Morris, C. et al. Functional outcome following rectal surgery—predisposing factors for low anterior resection syndrome. Int J Colorectal Dis 32, 691–697 (2017). https://doi.org/10.1007/s00384-017-2765-0

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