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Major low anterior resection syndrome has equivalent health-related quality of life implications as having a permanent colostomy

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Abstract

Background

The literature is inconclusive when comparing health-related quality of life following restorative anterior resection (AR) compared with abdominoperineal resection (APR). Consideration of functional outcomes may explain this inconsistency. The aim of this study was to compare health-related quality of life in patients post-anterior resection, stratified by low anterior resection syndrome score, and post-abdominoperineal resection patients.

Methods

A cross-sectional study of consecutive patients post APR and AR for rectal or sigmoid adenocarcinoma at a tertiary centre in Sydney, Australia (Jan 2012- Dec 2021) was performed. HRQoL outcomes (SF36v2 physical [PCS] and mental component summary [MCS] scores) were compared between APR and AR patients, with subgroup analyses stratifying AR patients according to LARS score (no/minor/major). Age- and gender-adjusted comparisons were performed by linear regression.

Results

Overall, 248 post-AR patients (57.3% male, mean age 70.8 years, SD 11.6) and 64 post-APR patients (62.5% male, mean age 68.1 years, SD 13.1) participated. When stratified by LARS, ‘major LARS’ had a similar negative effect on age-and sex-adjusted PCS scores as APR. ‘No LARS’ (p < 0.001) and ‘minor LARS’ (p < 0.001) patients had higher PCS scores compared to post-APR patients. ‘Major LARS’ had a similarly negative effect on MCS scores compared with post-APR patients. MCS scores were higher in ‘no LARS’ (p = 0.006) compared with APR patients.

Conclusions

Postoperative bowel dysfunction significantly impacts health-related quality of life. Patients with ‘major LARS’ have health-related quality of life as poor as those following APR. This requires consideration when counselling patients on postoperative health-related quality of life, especially where poor postoperative bowel function is anticipated following restorative surgery.

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Data availability

De-identified data can be made available with a request of the corresponding author due to patient privacy concerns.

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Acknowledgements

The authors thank the colorectal surgeons at Concord Hospital, Dr P Stewart, Dr M Suen, Dr H Cheung, Dr M Reece, Prof EL Bokey, A/Prof C Young and Dr A Gilmore who contributed patients to this study. And to Gael Sinclair who assisted with the management of the Concord Colorectal Cancer Database.

Funding

No external funding or grant support was obtained or received for the study. The authors declare that they have financial relationships to disclose.

Author information

Authors and Affiliations

  1. Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia

    S. Koneru, M. J. F. X. Rickard, A. Keshava, P. H. Chapuis & K.-S. Ng

  2. Division of Colorectal Surgery, Department of Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia

    S. Koneru, L. Builth-Snoad, M. J. F. X. Rickard, A. Keshava, P. H. Chapuis & K.-S. Ng

  3. Discipline of Surgery, School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    S. Koneru, M. J. F. X. Rickard, A. Keshava, P. H. Chapuis & K.-S. Ng

  4. Department of Colorectal Surgery, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia

    M. J. F. X. Rickard & A. Keshava

  5. Concord Institute of Academic Surgery, Concord, NSW, Australia

    K.-S. Ng

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  1. S. Koneru
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Contributions

All authors have made substantial contributions to the paper and are in agreement of all aspects of the work. Details regarding author contributions are as below. SK: Study conception and design; Data acquisition; Data analysis and interpretation; Drafting the article; Critical revision for intellectual content; Final approval of the manuscript; Agreement to be accountable for all aspects of the work in ensuring that questions regarding accuracy & integrity are investigated & resolved. LB-S: Data acquisition; Drafting the article; Final approval of the manuscript; Agreement to be accountable for all aspects of the work in ensuring that questions regarding accuracy & integrity are investigated & resolved. MJFXR: Study conception and design; Critical revision for intellectual content; Final approval of the manuscript; Agreement to be accountable for all aspects of the work in ensuring that questions regarding accuracy & integrity are investigated & resolved. AK: Study conception and design; Critical revision for intellectual content; Final approval of the manuscript; Agreement to be accountable for all aspects of the work in ensuring that questions regarding accuracy & integrity are investigated & resolved. PHC: Study conception and design; Drafting the article; Critical revision for intellectual content; Final approval of the manuscript; Agreement to be accountable for all aspects of the work in ensuring that questions regarding accuracy & integrity are investigated & resolved. KSNg: Study conception and design; Data acquisition; Data analysis and interpretation; Drafting the article; Critical revision for intellectual content; Final approval of the manuscript; Agreement to be accountable for all aspects of the work in ensuring that questions regarding accuracy & integrity are investigated & resolved.

Corresponding author

Correspondence to K.-S. Ng.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Sydney Local Health District Human Research Ethics Committee of Concord Repatriation General Hospital (CGRH). This study was conducted with appropriate informed consent of study participants.

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Koneru, S., Builth-Snoad, L., Rickard, M.J.F.X. et al. Major low anterior resection syndrome has equivalent health-related quality of life implications as having a permanent colostomy. Tech Coloproctol 28, 17 (2024). https://doi.org/10.1007/s10151-023-02879-y

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