Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study

Background: The prevalence of major low anterior resection syndrome (LARS) after rectal cancer surgery varies from 17 center dot 8 to 56 center dot 0 per cent, but data from high-quality studies are sparse. The aim of this study was to determine the prevalence of LARS and its association with quality of life (QoL) in a large, well defined, population-based cohort. Methods: This was a population-based study that included all patients who had curative rectal cancer surgery with total or partial mesorectal excision in Stockholm County in Sweden between 2007 and 2013. Patients without a remaining stoma, free from cancer and alive in April 2017 were eligible for the study. The LARS score questionnaire, EORTC QLQ-C30 and Cleveland Clinic Florida Fecal Incontinence score were used as outcome measures. Adjusted mean scores (and differences) of EORTC QLQ-C30 for LARS groups were calculated using repeated measures ANCOVA regression models while adjusting for predefined confounders. Results: In total, 481 patients (82 center dot 6 per cent response rate) were included in the analysis. Mean follow-up time was 6 center dot 7 (range 3 center dot 4-11 center dot 0) years after surgery. The prevalence of LARS was 77 center dot 4 per cent (370 of 478 patients), with 53 center dot 1 per cent (254 of 478) experiencing major LARS. Patients with major LARS reported worse on all EORTC QLQ-C30 subscales (except for financial difficulties) than patients without LARS. A higher mean LARS score was associated with a greater impact on bowel-related QoL. Conclusion: After anterior resection for rectal cancer, the majority of patients suffer from major LARS with a negative impact on QoL.