Factors influencing anterior/low anterior resection syndrome after rectal or sigmoid resections


Abstract: Background/aim: Sphincter-preserving surgery is one of the main goals in the treatment of rectal cancer because it improves the quality of life (QoL). However, some patients may experience disrupted symptoms called anterior or low anterior resection syndrome (LARS). This study was designed to evaluate the frequency and influencing factors of LARS in patients who underwent sigmoid or rectal resection. Materials and methods: In this retrospective, clinical study, patients who underwent rectal or sigmoid resection and anastomosis due to any benign and malignant reasons were evaluated in terms of LARS between January 2010 and November 2019 at Medical Faculty Hospital of Mersin University. The frequency and severity of LARS were determined by using a standard scale. Furthermore, influencing factors including lesion localization, operation, the proximity of anastomosis to the anal verge, creation of stoma, chemotherapy, and radiotherapy application were investigated. Results: Out of a total of 550 patients, 276 were included in this study. The major LARS incidence was found as 27.2%. Very low anterior resection (VLAR) (OR = 42.40 (95% CI [11.14-161.36], P < 0.0001), protective ileostomy (OR = 12.83 (95% CI [6.58-25.0], P < 0.0001), end colostomy (OR = 8.55 (95% CI [1.36-53.61], P = 0.022), receiving chemotherapy (OR = 3.08 (95% CI [1.71-5.53], P < 0.0001), and radiotherapy (OR = 2.51 (95% CI [1.38-4.57], P = 0.003) and the ROC analysis showed that creating an anastomosis placed at most 8.5 cm from the anal verge was found to be a major influencing factor on LARS (P < 0.05). Conclusions: LARS may frequently occur in patients who have undergone rectal resection. In this study, the most important factors influencing LARS were found to be the proximity of anastomosis to the anal canal and creating a protective stoma. Receiving chemoradiotherapy also plays an important role in LARS.

Keywords: Bowel dysfunction, low anterior resection syndrome, rectal cancer, quality of life

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