Low Anterior Resection Syndrome and Quality of Life After Sphincter-Sparing Rectal Cancer Surgery: A Long-term Longitudinal Follow-up

• Published in: Diseases of the colon & rectum Vol. 62; no. 1; pp. 14 - 20
• Main Authors: Pieniowski, Emil H.A, Palmer, Gabriella J, Juul, Therese, Lagergren, Pernilla, Johar, Asif, Emmertsen, Katrine J, Nordenvall, Caroline, Abraham-Nordling, Mirna
• Format: Journal Article
• Language: English
• Published: United States The American Society of Colon and Rectal Surgeons 01.01.2019
• Subjects: Medicin och hälsovetenskap
• ISSN: 0012-3706; 1530-0358; 1530-0358
• DOI: 10.1097/DCR.0000000000001228

BACKGROUND:Despite low anterior resection syndrome being a well-known consequence of sphincter-preserving rectal cancer surgery, the long-term effect on bowel function and quality of life is not fully understood. OBJECTIVE:This study aimed to elucidate whether symptoms of low anterior resection syndrome change over time and if the correlation to quality of life is equivalent when measured at 2 time points. DESIGN:This prospective cohort study included measurements at 2 time points (5 years between; range, 7.1–16.1 years from surgery to second follow-up). SETTINGS:This multicenter study included patients from Sweden and Denmark. PATIENTS:Patients were included if they were ≥18 years of age and underwent curative rectal cancer surgery with either total or partial mesorectal excision. MAIN OUTCOME MEASURES:Outcomes were measured with the low anterior resection syndrome questionnaire including a question assessing the impact of bowel function on quality of life and with the validated quality-of-life questionnaire EORTC QLQ-C30. RESULTS:In total, 282 patients were included and there were no statistically significant differences in the distribution among the 3 groups (no, minor, and major low anterior resection syndrome) when comparing time points follow-up 1 with follow-up 2 (p = 0.455). At follow-up 2, 138 patients (49%) still experienced major impairment. No both statistically and clinically significant differences were seen in the mean score of EORTC QLQ-C30 when comparing the same low anterior resection syndrome group at follow-up 1 and follow-up 2, and the impact on quality of life was comparable. Global health status/quality of life was impaired in the major low anterior resection syndrome group at both follow-up 1 (p < 0.001) and follow-up 2 (p < 0.001). LIMITATIONS:The study design prevents an evaluation of causality. CONCLUSIONS:Difficulties with low anterior resection syndrome and the impact on patients’ quality of life persist over time. See Video Abstract at http://links.lww.com/DCR/A762.