title: Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome.
abstract: OBJECTIVE
  Developments in surgical techniques and neoadjuvant treatment have enabled an increasing proportion of patients with rectal cancer to undergo sphincter-sparing resections. The avoidance of a permanent stoma can come at the cost of poor bowel function which can significantly impact patients' quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal cancer surgery.
  
  
  METHODS
  Patients undergoing anterior resection for rectal cancer between January 2009 and January 2015 were identified from a rectal cancer database at a single centre. All patients who had bowel continuity restored and underwent curative resection were sent a validated low anterior resection syndrome (LARS) questionnaire. Pre-, inter- and postoperative factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression.
  
  
  RESULTS
  There was an 80% response rate (n = 68). Thirty-eight patients (56%) had major LARS symptoms. Neoadjuvant radiotherapy, predominantly long-course chemoradiotherapy (LCCRT), was an independent risk factor for development of major LARS symptoms, while restoration of bowel continuity within 6 months was protective.
  
  
  CONCLUSIONS
  The use of neoadjuvant radiotherapy (LCCRT) and timing of stoma reversal are risk factors for the development of severe bowel dysfunction. The potential for long-term poor functional results after LCCRT should be discussed with patients and form a part of the decision-making in individual treatment plans. The timing of the ileostomy closure, where safe and feasible, should be performed within 6 months to improve outcome.
authors.affiliation: Department of Colorectal Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
authors.forename: Daniel Ll
authors.initials: DL
authors.lastname: Hughes
authors.affiliation: Department of Colorectal Surgery, Royal Glamorgan Hospital, Llantrisant, CF72 8XR, UK. julie.cornish@wales.nhs.uk.
authors.forename: Julie
authors.initials: J
authors.lastname: Cornish
authors.affiliation: Department of Colorectal Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003710:Demography; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D013577:Syndrome; D016896:Treatment Outcome
keywords: Functional outcomes; Low anterior resection syndrome