BACKGROUND:
The Delphi consensus identified eight symptoms and eight consequences as the highest priorities for defining low anterior resection syndrome.
OBJECTIVE:
To describe an exploratory scoring instrument that correlates the Delphi consensus on low anterior resection syndrome with functional and quality-of-life scores following intersphincteric resection for ultralow rectal cancer.
DESIGN:
This was a prospective pilot study. In accordance with the Wexner incontinence score, five frequency responses ranging from never (score 0) to always (score 4) were used to measure the severity of symptom- and consequence-specific variables.
SETTINGS:
Colorectal surgery referral center.
PATIENTS:
Among 161 eligible patients, 137 (85%) participants completed an electronic self-assessment survey regarding function and quality-of-life at scheduled follow-up, including 3 to 6, 12, and ≥ 24 months after ileostomy reversal.
MAIN OUTCOME MEASURES:
Outcome measures included patient-reported severity of these priorities, as well as its correlation with condition-specific quality-of-life.
RESULTS:
The most frequent symptom and consequence were “emptying difficulties” and “dissatisfaction with the bowels,” respectively. Aside from “emptying difficulties,” the proportions of negative symptom domains increased after reversal. In particular, both the frequency responses and the severity scores of “emptying difficulties” did not differ between groups. The percentages of “always option” for consequence domains improved at 12-months follow-up, whereas a higher rate was observed at 24-months later, except for “toilet dependence” and “dissatisfaction with the bowels.” We found significant improvements in the summary score of Fecal Incontinence Quality of Life Scale (p = 0.04) and our exploratory instrument (p = 0.009), but not in functional scores measured by traditional questionnaires. Furthermore, the condition-specific quality of life strongly correlated with the Delphi consensus severity score (r
s
= -0.73).
LIMITATIONS:
Single-institution data and limited sample size.
CONCLUSIONS:
The important priorities identified by the Delphi consensus might enable a comprehensive overview and a better assessment of low anterior resection syndrome after intersphincteric resection. See Video Abstract.