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Low Anterior Resection Syndrome and Quality of Life After Sphincter-Sparing Rectal Cancer Surgery

A Long-term Longitudinal Follow-up

Pieniowski, Emil H.A., M.D.1,2; Palmer, Gabriella J., M.D., Ph.D.2; Juul, Therese, R.N., M.H.Sc., Ph.D.3; Lagergren, Pernilla, R.N., Ph.D.2; Johar, Asif, M.Sc., B.Sc.(Hons.)2; Emmertsen, Katrine J., M.D., Ph.D.3,4; Nordenvall, Caroline, M.D., Ph.D.2; Abraham-Nordling, Mirna, M.D., Ph.D.2

Diseases of the Colon & Rectum: January 2019 - Volume 62 - Issue 1 - p 14–20
doi: 10.1097/DCR.0000000000001228
Original Contributions: Colorectal Cancer
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BACKGROUND: Despite low anterior resection syndrome being a well-known consequence of sphincter-preserving rectal cancer surgery, the long-term effect on bowel function and quality of life is not fully understood.

OBJECTIVE: This study aimed to elucidate whether symptoms of low anterior resection syndrome change over time and if the correlation to quality of life is equivalent when measured at 2 time points.

DESIGN: This prospective cohort study included measurements at 2 time points (5 years between; range, 7.1–16.1 years from surgery to second follow-up).

SETTINGS: This multicenter study included patients from Sweden and Denmark.

PATIENTS: Patients were included if they were ≥18 years of age and underwent curative rectal cancer surgery with either total or partial mesorectal excision.

MAIN OUTCOME MEASURES: Outcomes were measured with the low anterior resection syndrome questionnaire including a question assessing the impact of bowel function on quality of life and with the validated quality-of-life questionnaire EORTC QLQ-C30.

RESULTS: In total, 282 patients were included and there were no statistically significant differences in the distribution among the 3 groups (no, minor, and major low anterior resection syndrome) when comparing time points follow-up 1 with follow-up 2 (p = 0.455). At follow-up 2, 138 patients (49%) still experienced major impairment. No both statistically and clinically significant differences were seen in the mean score of EORTC QLQ-C30 when comparing the same low anterior resection syndrome group at follow-up 1 and follow-up 2, and the impact on quality of life was comparable. Global health status/quality of life was impaired in the major low anterior resection syndrome group at both follow-up 1 (p < 0.001) and follow-up 2 (p < 0.001).

LIMITATIONS: The study design prevents an evaluation of causality.

CONCLUSIONS: Difficulties with low anterior resection syndrome and the impact on patients’ quality of life persist over time. See Video Abstract at

1 Department of Surgery, South General Hospital (Södersjukhuset), Stockholm, Sweden

2 Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

3 Department of Surgery, Aarhus University Hospital, Aarhus, Denmark

4 Department of Surgery K, Regional Hospital Randers, Denmark

Funding/Support: This work was supported by the Bengt Ihre Foundation.

Financial Disclosure: None reported.

Correspondence: Emil Pieniowski, M.D., Department of Surgery, South General Hospital (Södersjukhuset), 118 83 Stockholm, Sweden. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons