The Longitudinal Course of Low-anterior Resection Syndrome

Abstract

Objective:We aimed to better understand the longitudinal course of low anterior resection syndrome (LARS) to guide patient expectations and identify those at risk of persisting dysfunction.Summary Background Data:LARS describes disordered bowel function after rectal resection that significantly impacts quality of life.Methods:MEDLINE, EMBASE, CENTRAL, and CINAHL databases were systematically searched for studies that enrolled adults undergoing anterior resection for rectal cancer and used the LARS score to assess bowel function at ≥2 postoperative time points. Regression analyses were performed on deidentified patient-level data to identify predictors of change in LARS score from baseline (3–6months) to 12-months and 18–24 months.Results:Eight studies with a total of 701 eligible patients were included. The mean LARS score improved over time, from 29.4 (95% confidence interval 28.6–30.1) at baseline to 16.6 at 36 months (95% confidence interval 14.2%–18.9%). On multivariable analysis, a greater improvement in mean LARS score between baseline and 12 months was associated with no ileostomy formation [mean difference (MD) –1.7 vs 1.7, P < 0.001], and presence of LARS (major vs minor vs no LARS) at baseline (MD –3.8 vs –1.7 vs 5.4, P < 0.001). Greater improvement in mean LARS score between baseline and 18–24 months was associated with partial mesorectal excision vs total mesorectal excision (MD–8.6 vs 1.5, P < 0.001) and presence of LARS (major vs minor vs no LARS) at baseline (MD –8.8 vs –5.3 vs 3.4, P < 0.001).Conclusions:LARS improves by 18 months postoperatively then remains stable for up to 3 years. Total mesorectal excision, neoadjuvant radiotherapy, and ileostomy formation negatively impact upon bowel function recovery.

Long-term Change of Low Anterior Resection Syndrome in Survivors of Rectal Cancer: Longitudinal Follow-up of a Randomized Controlled Trial

“…6 A meta-analysis suggested that the mean LARS score improved mostly within 18 months after surgery (from 29.4 to 20.4) and remained relatively stable from 18 to 36 months (20.4 vs 16.6). 5 Continuous LARS improvement was also observed in a cohort of 107 patients, mostly without neoadjuvant radiotherapy, with a 45% improvement in major LARS at 20 months and a 24% improvement at 38 months. 15 Over a longer time frame, serial follow-ups of 282 patients at 6.1 and 11.1 years showed slight improvement (53%-49%) in major LARS.…”

“…4 It is generally believed that symptoms of LARS improve within 1 to 2 years after surgery and remain stable afterward. 5,6 However, this is yet to be determined because long-term serial follow-up is lacking. In addition, patients who received ostomy because of severe postoperative dysfunction were often excluded by previous studies, impeding accurate assessment of the long-term impact of LARS.…”

Validity assessment of the POLARS score tool in the prediction of post rectal cancer surgery LARS score in a population-based Swedish cohort

“…The POLARS score was developed in a retrospective cohort from the UK and validated in a retrospective cohort from Denmark 9. Previously, it has been shown that LARS stabilises after 1.5 years and remains constant thereafter 17. The follow-up time in the UK (5.2 years), Danish (4.7 years) and the current study (6.7 years) are all longer than that, therefore the difference in follow-up time should not affect the results.…”

“…Oncological and surgical changes in the management of rectal cancer have occurred during this time. Preoperative RT is a known risk factor for postoperative bowel function following low anterior resection17 and there are differences in the treatment protocols for neoadjuvant RT. The proportion of patients receiving preoperative RT was 32% and 20% in the UK and Danish cohorts, respectively9 compared with a significantly higher proportion in the Swedish cohort, 67%.…”

“…Furthermore, it has been reported that LARS can improve postoperatively but persists relatively stable after 36-month follow-up. However, further investigations for long-term LARS needs to be performed 17. Almost 85% of patients with LARS experience a negative impact on quality of life (QoL) and around 40% still remains after 5 years 18…”