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The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer

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Abstract

Background

Low anterior resection (LAR) with total mesorectal excision (TME) for mid and low rectal cancer is standard of care, reducing local recurrence and enhancing long-term survival. However, this surgery is associated with a constellation of major defecatory problems that are collectively referred to as low anterior resection syndrome (LARS). The aims of this study were to evaluate the frequency of LARS in patients who have undergone LAR and to assess the impact of LARS on long-term quality of life (QoL).

Methods

This was a single-center prospective survey study on patients who underwent LAR and TME for low or mid rectal cancer between 2007 and 2015. LARS score and QLQ-C30 questionnaires were used to evaluate patient’s bowel functions and quality of life, respectively. Associations between LARS and QoL were evaluated.

Results

Fifty-seven patients out of 65 eligible agreed to participate in the study. Forty-three (66%) patients returned complete questionnaires. Five patients (11.6%) had no LARS, 7 had minor LARS (16.3%), and 31 had major LARS (72.1%). In univariate analysis, BMI > 30 kg/m2 was predictive of major LARS (p = 0.047). Major LARS did not impair global QoL (p = 0.75), function scores, or social scales, and was not associated with any of the symptom scores except for diarrhea (p = 0.02).

Conclusion

LARS is a frequent occurrence after LAR and TME for rectal cancer (72.1%) and is more prevalent in morbidly obese patients. However, the occurrence of LARS does not appear to have a direct impact on QoL except for the occurrence of diarrhea.

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Acknowledgments

We would like to acknowledge the contribution of a medical writer, Sandy Field, PhD, for the preparation and formatting of this manuscript.

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Author notes

  1. Ali Bohlok and Camille Mercier contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

    Ali Bohlok, Camille Mercier, Fikri Bouazza, Vincent Donckier, Issam El Nakadi & Gabriel Liberale

  2. Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

    Maria Gomez Galdon

  3. Department of Radiation Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

    Luigi Moretti

Authors
  1. Ali Bohlok
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  2. Camille Mercier
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  3. Fikri Bouazza
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  4. Maria Gomez Galdon
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  5. Luigi Moretti
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  6. Vincent Donckier
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  7. Issam El Nakadi
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  8. Gabriel Liberale
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Corresponding author

Correspondence to Gabriel Liberale.

Ethics declarations

All patients provided written informed consent, and the study was approved by the Institutional Scientific Committee (protocol 016) and the Ethics Committee of Institut Jules Bordet (CE2830).

Conflict of interest

The authors declare that they have no conflict of interest.

Synopsis

Defecatory problems may occur after low anterior resection with total mesorectal excision. This study evaluated the incidence of these problems and their impact on quality of life in patients who underwent surgery for mid or low rectal cancer.

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Bohlok, A., Mercier, C., Bouazza, F. et al. The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer. Support Care Cancer 28, 1199–1206 (2020). https://doi.org/10.1007/s00520-019-04901-2

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  • DOI: https://doi.org/10.1007/s00520-019-04901-2

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