The status of low anterior resection syndrome: data from a single-center in China

Abstract

Aim: The incidence and risk factors of low anterior resection syndrome (LARS) largely variate in different studies. In addition, there is lack of study on how patients evaluate the therapeutic effect of LARS. This single-center retrospective study aims to investigate the status of LARS in Chinese patients undergoing laparoscopic low anterior resection (LAR).

Methods: Consequent patients undergoing laparoscopic LAR and free from disease recurrence from January 2015 to May 2021 were issued with both LARS questionnaire and satisfaction survey. Related data were collected and analyzed.

Results: Both LARS questionnaires and self-made satisfaction survey were received from 261 eligible patients. The overall incidence of LARS was 47.1% (minor in 19.5%, major in 27.6%), decreased with the passage of postoperative time (64.7% within 12 months, and 41.7% within 12-36 months), and became stable 36 months later (39.7%). The most common symptoms were defecation clustering (n = 107/261, 41.0%) and defecation urgency (n = 101/261, 38.7%). According to the multivariable regression analysis, risk factors of major LARS were: 1 year increase in age (OR 1.035, 95% CI 1.004-1.068), protective stoma (OR 2.656, 95% CI 1.233-5.724) and T_{3 - 4} stage (OR 2.449, 95% CI 1.137-5.273). Most patients complained defecation disorder (87.3%) to doctors and 84.5% got suggestions or treatments for it. However, only 36.8% patients thought the treatments worked for them.

Conclusions: LARS frequently occurs after laparoscopic LAR, while the therapeutic effect is not satisfying. Elder, advanced T-stage and protective stoma were risk factors for postoperative major LARS.

Keywords: Bowel dysfunction; Low anterior resection syndrome; Quality of life; Rectal neoplasms; Satisfaction survey.

Fig. 1

The incidence and severity of LARS in three groups of different time to assessment. The incidence of LARS within 12 months postoperatively was 64.7%, and decreased significantly within 12–36 months (41.7%, P = 0.002), especially incidence of major LARS (44.1% vs. 20.9%). Compared with that within 12–36 months, the incidence of LARS became stable 36 months postoperatively (39.7%, P = 0.754)

Fig. 2

Incidences of 5 score components of LARS in three groups of different time to assessment. The incidences of cases who could not control flatus or had liquid stool leakage did not decrease significantly with time passage postoperatively. In contrast, in accord with decreasing incidence of major LARS, incidences of cases with bowels more than 7 times per day, open bowels within 1 h and strong urge to open bowels at least once per week decreased significantly in the group of 12–36 months when compared to those within 12 months

Fig. 3

The multivariable analysis of risk factors for major LARS. Age, protective stoma, T-stage, tumor height and diabetes were included in the multivariable model. Age (1 year increase) was associated with a 1.035 (95% CI: 1.004–1.068) increase in the odds of major LARS. Protective stoma and advanced T-stage (T_3 − 4) had an increase in the odds of major LARS at 2.656 (95% CI: 1.233–5.724) and 2.449 (95% CI: 1.137–5.273) compared to no protective stoma and local T-stage (T_1 − 2), respectively. Tumor height from the anal verge (1 cm decrease) and comorbid diabetes had an increase in the odds of major LARS, while the differences were not significant