Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life

Min Jung Kim, Ji Won Park, Mi Ae Lee, Han-Ki Lim, Yoon-Hye Kwon, Seung-Bum Ryoo, Kyu Joo Park, Seung-Yong Jeong, Min Jung Kim, Ji Won Park, Mi Ae Lee, Han-Ki Lim, Yoon-Hye Kwon, Seung-Bum Ryoo, Kyu Joo Park, Seung-Yong Jeong

Abstract

To identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504-43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504-43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100-4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Fecal incontinence severity index according to the severity of low anterior resection syndrome. LARS, low anterior resection syndrome. Figure was generated using GraphPad Prism version 8.4.2 for macOS, GraphPad Software, San Diego, California USA, https://www.graphpad.com.
Figure 2
Figure 2
Quality of life according to no, minor, and major low anterior resection syndrome. (a) EORTC QLQ-C30 according to no, minor, and major low anterior resection syndrome. (b) EORTC QLQ-CR29 according to no, minor, and major low anterior resection syndrome. Asterisk: Overall p < 0.05. EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ-CR29, European Organization for Research and Treatment of Cancer Questionnaire Module for Colorectal Cancer; LARS, low anterior resection syndrome; QOL, quality of life.
Figure 3
Figure 3
Fecal incontinence quality of life according to no, minor, and major low anterior resection syndrome. LARS, low anterior resection syndrome. Figure was generated using GraphPad Prism version 8.4.2 for macOS, GraphPad Software, San Diego, California USA, https://www.graphpad.com.
Figure 4
Figure 4
EORTC QLQ-C30 according to low anterior resection syndrome patterns. (a) EORTC QLQ-C30 according to low and high incontinence-dominant low anterior resection syndrome. (b) EORTC QLQ-C30 according to low and high frequency dominant low anterior resection syndrome. Asterisk: Overall p < 0.05. EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ-CR29, European Organization for Research and Treatment of Cancer Questionnaire Module for Colorectal Cancer; SD, standard deviation.

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Source: PubMed

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