title: Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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, of these, 938 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 time 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).
  
  
  CONCLUSIONS
  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 (compared with PME) are strong independent risk factors for major LARS.
authors.affiliation: Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Bregendahl
authors.forename: K J
authors.initials: KJ
authors.lastname: Emmertsen
authors.forename: J
authors.initials: J
authors.lastname: Lous
authors.forename: S
authors.initials: S
authors.lastname: Laurberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak; D002277:Carcinoma / Q000601:surgery* / Q000628:therapy; D016022:Case-Control Studies; D059186:Chemoradiotherapy, Adjuvant; D003430:Cross-Sectional Studies; D003672:Defecation / Q000502:physiology; D003718:Denmark; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000503:physiopathology*; D008197:Lymph Node Excision; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000503:physiopathology*; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Rectal cancer; bowel dysfunction; long-course chemoradiotherapy; partial mesorectal excision; short-course radiotherapy; total mesorectal excision