title: Long-Term Functional Outcomes of Total Mesorectal Excision Following Chemoradiotherapy for Lower Rectal Cancer: Stapled Anastomosis versus Intersphincteric Resection.
abstract: OBJECTIVE
  To compare the long-term functional outcomes of total mesorectal excision following chemoradiotherapy for lower rectal cancer between stapled anastomosis and intersphincteric resection (ISR).
  
  
  METHODS
  A total of 105 of 170 sphincter-preserving patients found to be disease-free and anal functional patients were assessed at 6.5 years (range 2.4-13.0 years) of follow-up after surgery. Of these subjects, 87 (double stapling technique [DST]: 41; ISR: 46) of the 105 patients (82.9%) responded to the questionnaire on the low anterior resection syndrome score (LARS score).
  
  
  RESULTS
  The total LARS scores in the DST and ISR groups were not significantly different (Major/Minor/No LARS = 23/14/4 and 31/10/5, p = 0.431). When considering each item of the LARS, ISR was associated with poorer incontinence scores than DST. Conversely, the scores for the frequency of bowel movement, clustering and urgency were not different between the 2 groups. In addition, in the multivariate analysis, the tumor distance from the anal verge and postoperative period was independently associated with Major LARS.
  
  
  CONCLUSIONS
  In this study, we demonstrate the long-term functional outcomes of irradiated lower rectal cancer reconstructed with DST and ISR. Bowel function improves over time; therefore, long-term patient follow-up is important.
authors.affiliation: Department of Surgery, Meiwa Hospital, Agenaruo-cho, Japan.
authors.forename: Naohito
authors.initials: N
authors.lastname: Beppu
authors.forename: Humihiko
authors.initials: H
authors.lastname: Kimura
authors.forename: Nagahide
authors.initials: N
authors.lastname: Matsubara
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yanagi
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D059186:Chemoradiotherapy, Adjuvant; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome