Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer

Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland Aim: The aim was to assess factors independently associated with low anterior resection syndrome (LARS) following resection for rectal cancer. Method: This was a cross-sectional study carried out in two acute-care teaching hospitals in Barcelona, Spain. Patients who had undergone sphincter-preserving low anterior resection with curative intent with total or partial mesorectal excision (with and without protective ileostomy) between January 2001 and December 2009 completed a self-administered questionnaire to assess bowel dysfunction after rectal cancer surgery. Predictors of LARS were assessed by univariate and multivariate analyses. Results: The questionnaire was sent to 329 patients (response rate 57.7%). Six cases of incomplete questionnaires were excluded. The study population included 184 patients (66.8% men) with a mean age of 63 years. There were 44 (23.9%) patients with no LARS, 36 (19.6%) with minor LARS and 104 (56.2%) with major LARS. In the univariate analysis, total mesorectal excision (P = 0.0008), protective ileostomy (P = 0.002), preoperative and postoperative radiotherapy (P = 0.0000), postoperative chemotherapy (P = 0.0046) and age (P = 0.035) were significantly associated with major LARS, whereas in the multivariate analysis total mesorectal excision (OR 2.18, 95% CI: 1.02–4.65), preoperative radiotherapy (OR 4.33, 95% CI: 2.03–9.27) and postoperative radiotherapy (OR 9.52, 95% CI: 1.74–52.24) were independent risk factors for major LARS. Conclusions: In this study, the risk of having major LARS increases with total mesorectal excision and both neoadjuvant and adjuvant radiotherapy.