Risk factors for low anterior resection syndrome

Objective: While low anterior resection avoided a permanent stoma, it might also cause bowel dysfunction 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 surgery.

Methods: Patients undergoing anterior resection for rectal neoplasm between January 2010 and December 2015 were identified from a rectal cancer database at the Department of Gastrointestinal Surgery, Beijing Hospital. All patients were asked to fill in a low anterior resection syndrome (LARS) questionnaire. Clinical factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression.

Results: There was 254 patients enrolled in the study. One hundred and eleven (44.1%) had major LARS symptoms. Neoadjuvant radiotherapy (OR=2.814, 95%CI: 1.097-5.561, P<0.001), low tumor location (OR=3.568, 95%CI: 1.159-6.546, P<0.001) and anastomotic leakage (OR=6.574, 95%CI: 1.689-15.367, P<0.001) were independent risk factors for development of major LARS symptoms.

Conclusions: For patients with high risk of low anterior resection syndrome, the potential for long-term poor functional results should be discussed with patients and form a part of the decision-making in individual treatment plans. Sphincter-preserving surgery should be performed in highly selected patients to avoid major bowel dysfunction.