Low Anterior Resection Syndrome And Quality Of Life Of Patients Post Sphincter Preservation Surgery: A Prospective Study

Background: Post AR one of the most debilitating syndrome is low anterior resection syndrome (LARS) seen in about 64% of patients. Severity of the LARS score was significantly correlated with neoadjuvant treatment, the extent of rectal surgery, complication by anastomotic leak, female gender and age < 64. In this study we had analysed the impact of various clinical factors on LARS and also the various domains of quality of life. Purpose: To assess incidence of LARS in patients undergoing sphincter sparing surgery for rectal cancer after the patient starts long term defecating per anus, change in the quality of life and relation to LARS and factors affecting it Methods: 72 patients who had undergone anterior resection in Regional Cancer, one year before were interviewed by the trained interviewer and data was collected from the file. The questionnaires used :Wexner Incontinence Score, LARS Malayalam Questionnaire, EORTC QLQ C30 Malayalam translations. Statistical measures The LARS score was used to categorise patients into 3 grades. The scores were compared with clinical and social factors using the χ2 test for association. Continuous variables were compared by the Spearman Rho test. Results: Details of patients were studied, (male: 55.6 % & female:44.4%) . 50 patients underwent low Anterior resection. Mean LARS score was 25.61, with 47.2% of patients having severe LARS score. Mean Wexner score was 6.84. The relation with type of surgery, approach (laparoscopic vs open), or type of neoadjuvant therapy were not found to be significant. Higher LARS score did not impact overall QoL as assessed by FACT-C. Insomnia and diarrhoea symptoms scores were significantly worsened. Pain score was worse for those undergoing stapler anastomosis. Wexner's score was worse for those who had received adjuvant chemotherapy. Role functioning score was better for AR compared to low anterior resection. Only distance from anal verge was found to be a significant cause of LARS and was negatively correlated Discussion: LARS of severe degree were seen in most patients. No modifiable risk factors were significantly found to affect the chance of LARS. But LARS did not have a significant impact on quality of life, neither did the type of surgery. So sphincter preservation can be offered to the patients, but all patients undergoing Low Anterior Resection should be counselled well about the risk of LARS before surgery.