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Trajectory of change of low anterior resection syndrome over time after restorative proctectomy for rectal adenocarcinoma

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Abstract

Background

Restorative proctectomy for rectal cancer is associated with a high incidence of low anterior resection syndrome (LARS), but few studies report longitudinal results for bowel function. The aim of our study was to examine the trajectory of change of LARS over the first 18 months after restorative proctectomy for rectal cancer.

Methods

A prospective database measuring functional outcomes in rectal cancer patients from a single university-affiliated specialist colorectal referral center from 10/2018 to 03/2020 was queried. Patients were included in this study if they underwent restorative proctectomy for rectal cancer and had at least three assessments in the first 18 months after primary surgery or after closure of proximal diversion. Bowel function was assessed using the LARS score, administered at every surveillance follow-up after restoration of bowel continuity. Latent-class growth curve (trajectory) analysis was used to identify different trajectories of LARS changes over the first 18 months and group patients into these trajectory groups. These groups were then compared to identify predictors for each trajectory.

Results

A total of 95 patients were included (63 males, mean age. 61.3 ± 12.5 years). Trajectory analysis identified three distinct trajectory groups. Group 1 had stable minimal LARS over time (26%). Group 2 had early LARS scores consistent with the minor LARS category and improved with time (28%). Group 3 had persistently high LARS scores (45%). Neoadjuvant therapy, intersphincteric resection, and proximal diversion were more common in group 3.

Conclusions

We identified three main trajectories of change of LARS in the 18 months after restorative proctectomy. These data may be used to better inform patients of their expected postoperative bowel function.

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Data availability

Data are available upon reasonable request.

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Funding

The research leading to these results received funding from the American Society of Colon and Rectal Surgeons Career Development Award under grant agreement CDA-019 (recipient: Lawrence Lee).

Author information

Authors and Affiliations

  1. Colon and Rectal Surgery, Department of Surgery, McGill University Health Centre, 1001 boulevard Decarie DS1-3310, Montreal, QC, H4A 3J1, Canada

    F. Al-Rashid, A. S. Liberman, P. Charlebois, B. Stein & L. Lee

  2. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    S. Robitaille, A. S. Liberman, P. Charlebois, B. Stein, L. S. Feldman, J. F. Fiore Jr & L. Lee

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  1. F. Al-Rashid
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  2. S. Robitaille
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  4. P. Charlebois
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  5. B. Stein
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  6. L. S. Feldman
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  7. J. F. Fiore Jr
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  8. L. Lee
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Contributions

Conception and design: FA, SR, LSF, JFF, LL. Acquisition of data: FA, SR, ASL, PC, BS, LL. Analysis and interpretation of data: FA, SR, ASL, PC, BS, LSF, JFF, LL. Drafting the manuscript: FA, SR, LL. Critical revision: ASL, PC, BS, LSF, JFF, LL. Final approval of the version to be published: FA, SR, ASL, PC, BS, LSF, JFF, LL.

Corresponding author

Correspondence to L. Lee.

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Conflict of interests

The authors have no relevant financial interests to disclose. LL is the recipient of an investigator-initiated research grant from Johnson & Johnson and receives speaker fees from Stryker. LSF is the recipient of an investigator-initiated research grant from Merck. JFF is the recipient of an investigator-initiated research grants from Merck and receives consulting fees from Shinogi. SL receives consulting fees from Merck. FA, SR, PC, and BS have nothing to disclose.

Ethical approval

The study protocol was approved by the Research Ethics Board of the McGill University Health Centre Research Institution (TME/2018–3864).

Consent to participate

Participation in this study was voluntary and all subjects signed informed consent to participate.

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Al-Rashid, F., Robitaille, S., Liberman, A.S. et al. Trajectory of change of low anterior resection syndrome over time after restorative proctectomy for rectal adenocarcinoma. Tech Coloproctol 26, 195–203 (2022). https://doi.org/10.1007/s10151-021-02561-1

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  • DOI: https://doi.org/10.1007/s10151-021-02561-1

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