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Low anterior resection syndrome and quality of life after intersphincteric resection for rectal cancer: a propensity score-matched study

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Abstract

Purpose

Our aim was to perform a propensity score-matched study to compare the long-term functional outcomes and quality of life following intersphincteric resection vs. low anterior resection (LAR) with very low anastomosis.

Methods

Patients who underwent intersphincteric resection or low anterior resection with low anastomosis (≤ 4 cm from the anal verge) for rectal cancer between January 2017 and June 2020 were retrospectively included. A propensity score-matching process was performed. Functional outcomes and quality of life were assessed using the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), EORC-QLQ C30, EORC-QLQ CR29, Low Anterior Resection Syndrome (LARS), Wexner, and International Prostate Symptom Score (IPSS) questionnaires. The primary outcome was the presence of LARS at least 12 months after surgery. The second outcome was the postoperative quality of life of included patients.

Results

After propensity matching, 128 patients were included, including 58 males and 70 females with a median age of 59.5. Patients in the intersphincteric resection group showed a higher incidence of incontinence to flatus (32.8% versus 14.0%, p = 0.043) and stools (42.2% versus 21.9%, p = 0.046), pain/discomfort (25.0% versus 7.8%, p = 0.001), and bowel dysfunction, while the LARS scores (15.0 versus 13.2, p = 0.461) and major LARS rates (26.6% versus 14.1%, p = 0.078) were comparable in both groups.

Conclusion

ISR leads to increased bowel incontinence rate and increased anal pain, without affecting the grade of low anterior resection syndrome, fecal urgency, and clustering. LAR might be the preferred sphincteric-preserving approach when negative resection margins and a safe anastomosis are guaranteed. Patients should be fully informed about potential functional impairment after sphincter-preservation procedures.

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Data availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the Department of Science and Technology of Sichuan Province (No. 2021YFS0025), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (No. 20HXJS003), 1·3·5 Project for Disciplines of Excellence—Clinical Research Incubation Project, and West China Hospital, Sichuan University (No. 22HXFH001 and 2019HXFH031). Attributed to: West China Hospital, Sichuan University, Chengdu, Sichuan, China. Whether the paper has been or will be a podium or poster meeting presentation: No.

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Author notes

  1. Yu Shen and Tinghan Yang have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China

    Y. Shen, T. Yang, W. Meng, X. Deng, M. Wei & Z. Wang

  2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

    H. Zeng

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Contributions

YS and TY designed the study, gathered, and analyzed the data and drafted the article; MW, XD, HZ, and WM gathered the data and revised the draft; ZW revised the article and approve the version to be published.

Corresponding authors

Correspondence to X. Deng, M. Wei or Z. Wang.

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Conflict of interest

We declare there is no conflict of interest.

Informed consent

Written informed consents have been obtained from all included patients.

Ethical approval

The study was approved by the appropriate Biomedical Ethics committee of West China Hospital, Sichuan University (2019.No.194) and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Supplementary information

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10151_2023_2848_MOESM3_ESM.docx

Supplementary file3 (DOCX 36 KB) Questionnaires (English version) of EQ-5D-3L, EORC-QLQ C30, EORTC-QLQ CR29, low anterior resection syndrome (LARS), Wexner incontinence score, and the International Prostate Symptom Score (IPSS). Chinese versions have been used in the current study

Supplementary file4 (DOCX 13 KB)

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Shen, Y., Yang, T., Zeng, H. et al. Low anterior resection syndrome and quality of life after intersphincteric resection for rectal cancer: a propensity score-matched study. Tech Coloproctol 27, 1307–1317 (2023). https://doi.org/10.1007/s10151-023-02848-5

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