Treatment of Low Anterior Resection Syndrome in Specialized Multidisciplinary Late Sequelae Clinics: A Prospective Cohort Study

Abstract

Objective: To evaluate the outcomes of a multidisciplinary effort involving surgical and gastroenterological departments in managing bowel dysfunction, specifically low anterior resection syndrome (LARS), following rectal cancer treatment.

Summary background data: An increasing number of rectal cancer survivors experience LARS, heightening the need for specialized treatment.

Methods: Patients referred to our late sequelae clinics with LARS following sphincter-preserving treatment were eligible for inclusion. Patients were treated in the surgical or gastroenterological units or both based on symptoms. Patients completed patient-reported outcome measures at the first visit, upon discharge, and 12 months after discharge. Treatment outcomes were evaluated by the LARS score and its five single items, six single items covering additional LARS symptoms, the EuroQoL 5-dimension 5-level (EQ-5D-5L) VAS and utility scores, self-rated bowel function, and bowel function impact on quality of life (QoL).

Results: We included 201 patients. Three-quarters were treated in the surgical units, whereas the rest required gastroenterological treatment. After treatment, the mean LARS score decreased by 4.7 points (P<0.001), whereas the mean EQ-VAS and utility score increased by 7.1 (P<0.001) and 0.06 points (P<0.001), respectively. All individual symptoms significantly improved. Improvement in self-rated bowel function and bowel function impact on QoL were 55.8% (P<0.001) and 45.7% (P<0.001), respectively. Similar results were recorded at the 12-month follow-up.

Conclusion: These results encourage establishing late sequelae clinics with a joint gastroenterological and surgical approach to treat LARS following rectal cancer treatment.