Anterior Resection Syndrome and Quality of Life with Long-term Follow up After Rectal Cancer Resection.

BACKGROUND Surgical and systemic therapies continue to advance, enabling restorative resections for distal rectal cancer. These operations are associated with low anterior resection syndrome. Recent studies with methodological and size limitations have investigated the incidence of low anterior resection syndrome after anterior resection. However, the long-term trajectory of low anterior resection syndrome and its effect on health-related quality-of-life remain unclear. OBJECTIVE To assess the impact of anterior resection and reversal of ileostomy on long term health-related quality-of-life and low anterior resection syndrome. SETTING Patients who underwent anterior resection of the rectum for cancer with defunctioning ileostomy between 2003 and 2016 at two high-volume centers in the United Kingdom were identified, excluding those suffering anastomotic leakage. DESIGN Patient demographics were analyzed alongside low anterior resection syndrome and health-related quality-of-life qualitative scores (EORTC-QLQ-C30) obtained through cross-sectional postal questionnaires. PATIENTS Amongst 478 eligible patients, 311 (65.1%) participated at a mean of 6.5±0.2 years after anterior resection. Demographics and neoadjuvant chemoradiotherapy rates were similar (p>0.05) between participants and non-participants. RESULTS The percentage of patients who experienced major low anterior resection syndrome was 53.4% (166/311). MAJOR OUTCOME MEASURES Health-related quality-of-life functional domain scores improved in the years following reversal of ileostomy, with significant changes in constipation (p=0.01), social function (p=0.03) and emotional scores (p=0.02), as well as a reduction in the prevalence of major low anterior resection syndrome (p=0.003). LIMITATIONS The main limitation of this study was that the data collected was cross-sectional rather than longitudinal, and that non responders may have had worse cancer symptoms. CONCLUSIONS In this first large-scale study assessing long-term function following anterior resection and reversal of ileostomy, there is a linear improvement in major low anterior resection syndrome beyond 6 years, alongside improvements in key quality-of-life measures. See Video Abstract at http://links.lww.com/DCR/B825.