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

Abstract

Aim: 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. Method: We identified all patients who underwent curative resection for rectal cancer in D enmark 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. Results: 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). Conclusion: 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.