Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study

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AIM: Bowel dysfunction was assessed after low anterior resection with and without neoadjuvant therapy (NT) for rectal cancer using a novel symptom-based scoring system correlated with quality of life. METHOD: We identified all patients who underwent curative resection for rectal cancer in Denmark between 2001 and 2007. A questionnaire on bowel function and quality of life, including the recently validated 'Low Anterior Resection Syndrome Score' (LARS-score; range 0-42) was administered to recurrence-free patients in 2009. We used multivariate analysis to examine the association between major LARS (LARS-score≥30) and a number of patient and treatment-related factors. RESULTS: Of 1087 eligible patients, 980 agreed to participate, and a final 938 patients were included in the analysis. Major LARS was observed in 41%. The use of NT (OR=2.48; 95% CI 1.73-3.55), long course chemoradiotherapy vs short-course radiotherapy (OR=0.90; 95% CI 0.44-1.87), total mesorectal excision (TME) vs partial mesorectal excision (PME) (OR=2.31; 95% CI 1.69-3.16), anastomotic leakage (OR=2.06; 95% CI 0.93-4.55), age≤64 years at surgery (OR=1.90; 95% CI 1.43-2.51), and female gender (OR=1.35; 95% CI 1.02-1.79) were associated with major LARS. No association was found between major LARS and the interval since surgery (OR=0.78; 95% CI 0.59-1.04) or neorectal reconstruction (colonic pouch vs. straight colorectal or side-to-end anastomosis (OR=0.96; 95% CI 0.63-1.46). CONCLUSION: Severe bowel dysfunction is a frequent long-term outcome after resection for rectal cancer. Use of NT, regardless of a long or short course protocol, and TME (as opposed to PME) are strong independent risk factors for major LARS. This article is protected by copyright. All rights reserved.
TidsskriftColorectal Disease
Sider (fra-til)714-718
Antal sider5
StatusUdgivet - maj 2013

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