Anterior resection syndrome : contributing factors and its impact on quality of life

Abstract

BACKGROUND: In Europe, colorectal cancer is the second most common cancer in women and third most common in men. Around half of all colorectal cancer cases affect the rectum. Surgery is the main curative therapy for rectal cancer however this is associated with bowel functional disturbances post anterior resection. The wide spectrum of symptoms following resection and restitution of rectum is what constitutes anterior resection syndrome.

METHODS: Adult patients who had undergone anterior resection between January 2014 and December 2016 were recruited. Variable factors for LARS were collected retrospectively from clinical records. Data was collected using validated questionnaires, namely LARS scale and EORTC QLQ-C30. Statistical analysis included ordinal logistic regression, one-way ANOVA and Scheffe post-hoc test.

RESULTS: Between January 2014 and December 2016, 179 patients had undergone anterior resection, with 55 patients fulfilling the inclusion criteria. Symptoms of LARS were identified in 51% of patients (n=27); with 23% (n=13) classified as minor and 28% (n=15) as major. Ordinal logistic regression showed that distance from anal verge (p=0.02), preoperative radiotherapy (p=0.01) and presence of stoma (p=0.02) were significantly associated with LARS. Patients who suffered from major LARS were noted to have a significant decrease in their quality of life.

DISCUSSION: Patients with anterior resection for rectal cancer suffer from anterior resection syndrome adversely impacting their quality of life. Identification of factors contributing to LARS and its impact on the quality of life allows for better patients stratification in treatment groups and provision of individualised management plan.