Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer

Background: Bowel dysfunction after sphincter-preserving surgery for rectal cancer is a common complication, with the potential to affect quality of life (QoL) strongly. The aim of this study was to examine the extent of bowel dysfunction and impact on health-related QoL after curative sphincter-preserving resection for rectal cancer. Methods: QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, and bowel function using a validated questionnaire, including the recently developed low anterior resection syndrome (LARS) score. Assessments were carried out at the time of diagnosis, and at 3 and 12months after surgery. Results: A total of 260 patients were included in the study. At 3 months, 58.0 per cent of patients had a LARS score of 30 or more (major LARS), which declined to 45.9 per cent at 12 months (P < 0.001). The risk of major LARS was significantly increased in patients who received neoadjuvant therapy (odds ratio 2.41, 95 per cent confidence interval 1.00 to 5.83), and after total versus partial mesorectal excision (odds ratio 2.81, 1.35 to 5.88). Global health status was closely associated with LARS, and significant differences in global health status, functional and symptom scales of QoL were found between patients without LARS and those with major LARS. Conclusion: Bowel dysfunction is a major problem with an immense impact on QoL following sphincter-preserving resection. The risk of major LARS was significantly increased after neoadjuvant therapy and total mesorectal excision.