Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study.

Abstract

Bowel dysfunction was assessed after low anterior resection with and without neoadjuvant therapy (NT) for rectal cancer using a novel symptom-based scoring system correlated with quality of life. We identified all patients who underwent curative resection for rectal cancer in Denmark between 2001 and 2007. A questionnaire on bowel function and quality of life, including the recently validated low anterior resection syndrome score (LARS score; range 0-42) was administered to recurrence-free patients in 2009. We used multivariate analysis to examine the association between major LARS (LARS score ≥ 30) and a number of patient and treatment-related factors. Of 1087 eligible patients, 980 agreed to participate and, of these, 938 were included in the analysis. Major LARS was observed in 41%. The use of NT (OR = 2.48; 95% CI: 1.73-3.55), long-course chemoradiotherapy vs short-course radiotherapy (OR = 0.90; 95% CI: 0.44-1.87), total mesorectal excision (TME) vs partial mesorectal excision (PME) (OR = 2.31; 95% CI: 1.69-3.16), anastomotic leakage (OR = 2.06; 95% CI: 0.93-4.55), age ≤ 64 years at surgery (OR = 1.90; 95% CI: 1.43-2.51) and female gender (OR = 1.35; 95% CI 1.02-1.79) were associated with major LARS. No association was found between major LARS and the time since surgery (OR = 0.78; 95% CI: 0.59-1.04) or neorectal reconstruction (colonic pouch vs straight colorectal or side-to-end anastomosis (OR = 0.96; 95% CI: 0.63-1.46). Severe bowel dysfunction is a frequent long-term outcome after resection for rectal cancer. Use of NT, regardless of a long- or short-course protocol, and TME (compared with PME) are strong independent risk factors for major LARS.