Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study

Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study Ditte Reitz Petersen, Pia Møller Faaborg, Issam Al-Najami, Maja Mi Thygesen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6975954/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : This study aimed to characterize bowel function, anorectal physiology, and health-related quality of life (HRQoL) in rectal cancer patients following low anterior resection (LAR), comparing three groups: a control group with late stoma closure (LSC) (>3 months), an early stoma closure group (ESC) (8-10 days), and an anastomotic leakage group (AL). Methods : This cross-sectional study evaluated anorectal function using anorectal manometry. Bowel function and HRQoL were assessed using the low anterior resection syndrome (LARS) score and the EORTC QLQ-CR29 questionnaires. Results : Of 124 eligible participants, 42 accepted participation. ESC and AL had significantly lower median (IQR) pressures in mmHg compared to LSC: rest: LSC: 54 (50-77), ESC: 35 (20-45), AL: 28 (22.5-33), p=0.001, p<0.001; squeeze: LSC: 140 (95-168), ESC: 70 (46-95), AL: 71 (45-81.5), p=0.010, p=0.004; squeeze pressure increments: LSC: 72 (60-89), ESC: 36 (30-48) and AL: 38 (25.5-54), p=0.003, p=0.004. ESC showed higher but non-significant median (IQR) volumes in ml: first sensation: LSC: 30 (20-40), ESC: 40 (30-50), p=0.153; urge: LSC: 55 (45-100), ESC: 90 (65-100) p=0.269; max: LSC: 110 (80-180), ESC: 142 (105-179), p=0.713. No differences in mean (95% CI) total LARS scores were observed: LSC: 26.5 (21.9-31.1), ESC: 29.5 (25.9-33.1), AL: 33.0 (28.0-38.0), p=0.320, p=0.051. Mean (95% CI) stool frequency was significantly higher in AL: 44.4 (32.1-56.8) compared to LSC: 29.4 (20.5-38.4), p=0.041. No differences in HRQoL were observed between the groups (p=0.681, p=0.129). Conclusion : No differences in anorectal function and HRQoL were observed between early and late reversal of diverting loop ileostomy. Rectal Neoplasms Manometry Low Anterior Resection Syndrome Quality of Life Figures Figure 1 INTRODUCTION Low Anterior Resection (LAR) with Total Mesorectal Excision (TME) is the standard surgical modality for treating rectal cancers. Bowel dysfunction following LAR is a well-known problem among patients treated for rectal cancer and is referred to as low anterior resection syndrome (LARS) [ 1 ]. Previous studies have shown a prevalence of LARS in 60–90% after LAR [ 1 ]. The most frequently reported symptoms are faecal incontinence, fragmented bowel movements, flatus incontinence and urgency [ 2 ]. As a consequence of the changes in bowel function, many patients experience affected health-related quality of life (HRQoL) [ 3 , 4 ]. Risk factors for LARS include neoadjuvant radiotherapy (RT), diverting loop ileostomy, low anastomosis and anastomotic leakage [ 5 – 8 ]. Neoadjuvant RT is associated with internal sphincter dysfunction and reduced capacity, which corresponds with LARS [ 8 ]. Nerve damage and radiation-induced fibrosis may cause this [ 9 ]. Other studies have found that female sex is also associated with an increased risk of LARS [ 10 , 11 ]. Furthermore, the timing of diverting ileostomy reversal may impact postoperative bowel function [ 12 , 13 ]. Anorectal manometry is used as an objective measure of anorectal function and continence and has been shown to be impaired following LAR [ 14 – 16 ]. Resting anal sphincter pressure is lower in rectal cancer patients treated with LAR [ 14 ]. Furthermore, rectal sensitivity is affected in patients following LAR, and they produce reduced volumes at first sensation and urge to defecate [ 14 ]. Previous studies have evaluated and compared the early reversal of diverting loop ileostomy (8–10 days) with the late reversal of diverting loop ileostomy (> 3 months), focusing primarily on stoma-related complications [ 17 , 18 ], mortality, morbidity [ 19 ], HRQoL, and LARS [ 20 , 21 ]. These studies have shown mixed results, with no clear consensus on the optimal timing for ileostomy reversal. However, the objective anorectal function and continence measured by anorectal physiological tests, and their association with HRQoL, are not well researched when comparing early and late reversal of diverting loop ileostomy. Additionally, previous studies have found that anastomotic leakage is associated with impaired functional outcomes [ 22 ], including an increased risk of major LARS [ 23 , 24 ], and reduced HRQoL [ 25 ], which may be due to inflammation [ 26 ] and pelvic fibrosis [ 27 ]. Therefore, this study aimed to evaluate functional and pathophysiological changes in the rectum after LAR via anal physiological examination in three different groups of rectal cancer patients: a late stoma closure (LSC) group, an early stoma closure (ESC) group, and an anastomotic leakage (AL) group. Secondly, patient-reported outcomes were compared using questionnaires, including the LARS score and EORTC QLQ-CR29. METHODS Ethics statements This study followed the ethical principles of the Declaration of Helsinki. Ethical approval was granted by The Regional Committees on Health Research Ethics for Southern Denmark (ID S-20150074). All participants gave written informed consent before inclusion. Participants Three groups of rectal cancer patients treated with LAR were compared. The LSC group served as the control group and included patients who had a diverting loop ileostomy for at least three months. The ESC group included patients who underwent reversal of diverting loop ileostomy eight to ten days after LAR. The AL group was the complication group and included patients who suffered a CT-verified anastomotic leak but were treated with preserved anastomosis following LAR. They had a delayed stoma reversal performed (Table 1 ). Table 1 Study population baseline characteristics Characteristic LSC group ESC group AL group P-value a P-value b Total 17 (40%) 13 (31%) 12 (29%) NA NA Male/female 13 (76%) / 4 (24%) 8 (62%) / 5 (38%) 8 (67%) / 4 (33%) 0.443 0.683 BMI 26.5 (24.8–28.3) 28.7 (26.8–31.2) 27.25 (24.4–29.6) 0.065 0.876 Non-smoking 17 (100%) 10 (77%) 10 (83%) 0.070 0.163 Excess alcohol consumption 1 (6%) 0 (0%) 3 (25%) 1.000 0.279 Performance score 0.687 0.553 PS0 16 (94%) 12 (92%) (83%) PS1 1 (6%) 0 (0%) 2 (17%) PS2 0 (0%) 1 (8%) 0 (0%) Preoperative chemotherapy 0.454 0.621 None 13 (76%) 8 (62%) (75%) Radiation 0 (0%) 1 (8%) (8%) Chemoradiotherapy 4 (24%) 2 (23%) 2 (17%) Chemotherapy 0 (0%) 1 (8%) 0 (0%) Days to stoma closure 118 (96–162) 8 (8–10) 212.5 (103-268.5) < 0.001* 0.362 Days from stoma closure to anorectal physiological examinations 683 (561–826) 733 (594–964) 817.5 (564-1318.5) 0.713 0.362 Values are presented as number (%) or median (interquartile range). LSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; NA, not available. a LSC group vs ESC group; b LSC group vs AL group. * P < 0.05. Study participants were identified among former rectal cancer patients who had previously participated in research studies from our group (N = 279) [ 28 , 29 ]. All had consented to be invited to further studies based on the inclusion criteria: age > 18 years, being > 1 and < 4 years post primary surgery (LAR) or reversal of diverting loop ileostomy. Exclusion criteria included patients who were pregnant or breastfeeding, patients who were not considered capable of following the planned examination protocol, patients who had previous major surgery in the region, and patients who had previously received radiotherapy in the area for other diseases. Anorectal physiological examinations An expert specialist (PF) performed anorectal physiology examinations under standard conditions. Before the examination, participants fasted for two hours and emptied their urinary bladder. Anorectal manometry was conducted using the ManoScanTM Anorectal High Resolution Manometry System (Medtronic, MN, USA). Anal resting pressure, squeeze pressure, and squeeze pressure increments, as well as the rectal volume at first sensation, urge to defecate, and maximum tolerable volume, were measured three consecutive times. Results were reported as the mean value. Before the anorectal physiological examinations, a digital rectal examination, a proctoscopy, and a 3D anorectal ultrasound were performed to ensure there were no clinical signs of recurrence or other significant anorectal diseases that could affect the results. If the rectum was not empty during the digital examination, a rectal enema (Microlax®, McNeil, Birkeroed, Denmark) was administered. All examinations were conducted with the patient in the left lateral position. Across all groups, anorectal physiological examinations were performed approximately two years after stoma closure. Questionnaires On the examination day, all study participants completed the LARS score and the EORTC QLQ-CR29 questionnaires, specific for colorectal cancer and used to evaluate subjective bowel function and HRQoL. Outcomes The primary outcome of this study was functional and pathophysiological changes in the neorectum following LAR assessed by anorectal physiological examinations. The secondary outcomes were patient-reported bowel dysfunction and HRQoL evaluated using the LARS score and EORTC QLQ-CR29. The LARS score was stratified by severity into three predefined groups: no LARS (0–20 points), minor LARS (21–29 points), and major LARS (30–42 points) [ 1 ]. Statistical methods We presented categorial characteristics as counts and proportions and compare these between groups using Fisher’s exact test. Numerical characteristics are presented as medians with interquartile ranges (IQR) and compared by a k-sample test for equality of medians. The LARS total score and the EORTC QLQ-CR29 scales are compared using linear regression and reported as means with a 95% confidence interval, applying bootstrapping with 1000 repetitions to take into account the non-normality of scores. We did not perform a sample size calculation as this study was an observational study on a pragmatically chosen cohort of available patients. P < 0.05 was considered statistically significant. Analyses were performed using Stata 18. RESULTS Among the 279 potential participants from the two original studies [ 28 , 29 ], 98 individuals did not meet the inclusion criteria and were excluded because of death, cancer recurrence, or a permanent stoma performed. This left 181 eligible participants who were screened for inclusion. Subsequently, an additional 57 participants were excluded, as more than four years had elapsed since their surgery. This ensured a less diverse study population with no difference in time since stoma reversal. Ultimately, 124 participants met the inclusion criteria and were invited to participate in the study. Of these, 42 accepted participation and were included in the final analysis (Fig. 1 ). Baseline characteristics were similar across the three groups (Table 1 ). Anorectal measurements were successfully conducted for all participants, and the overall questionnaire response rate was 100%, except for specific items in the EORTC QLQ-CR29 questionnaire regarding dyspareunia, sexual interest, and stoma care problems. Anorectal physiological examinations Median anal resting pressure was significantly lower in the ESC and AL groups compared to the LSC group (ESC 35 mmHg and AL 28 mmHg vs. LSC 54 mmHg, p = 0.001 and p < 0.001, respectively). Median squeeze pressure was lower in the ESC and AL groups as well (ESC 70 mmHg and AL 71 mmHg vs. LSC 140 mmHg; p = 0.010 and p = 0.004). Similarly, the median squeeze pressure increment was reduced in the ESC and AL groups (ESC 36 mmHg and AL 38 mmHg vs. LSC 72 mmHg; p = 0.003 and p = 0.004). In the rectal sensation test, volumes were higher in the ESC group, however, these were not statistically significant (Table 2 ). Table 2 Anorectal physiological examination results in the three groups Characteristic LSC group ESC group AL group P-value a P-value b Total 17 (40%) 13 (31%) 12 (29%) NA NA Anal manometry (mmHg) Rest 54 (50–77) 35 (20–45) 28 (22.5–33) 0.001* < 0.001* Squeeze 140 (95–168) 70 (46–95) 71 (45-81.5) 0.010* 0.004* Squeeze pressure increment 72 (60–89) 36 (30–48) 38 (25.5–54) 0.003* 0.004* Ballon, rectal sensation (ml) Balloon first 30 (20–40) 40 (30–50) 27.5 (20–45) 0.153 0.979 Balloon urge 44 (45–100) 90 (65–100) 60 (37.5–105) 0.269 0.979 Balloon max 110 (80–180) 142 (105–179) 90 (72.5–130) 0.713 0.176 Rectal inhibitory reflex Intact 16 (94%) 10 (77%) 11 (92%) 0.290 1.000 Values are presented as number (%) median (interquartile range). LSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; NA, not available. a LSC group vs ESC group; b LSC group vs AL group. * P < 0.05. LARS scores There were no statistically significant differences between the three groups in the LARS score, except for question 1 (regarding controlling flatus), where a significant difference was found between the LSC and ESC groups (LSC: 9 patients (53%) reported more than once per week, ESC: 8 (62%); p = 0.050). No significant differences in the impact on overall quality of life were observed between the groups (Table 3 ). Table 3 Low anterior resection syndrome (LARS) scores in the three groups Characteristic LSC group ESC group AL group P-value a P-value b 1. Do you ever have occasions when you cannot control your flatus (wind)? 0.050* 0.105 No 7 (41%) 1 (8%) 1 (8%) Yes, less than once per week 1 (6%) 4 (31%) 1 (8%) Yes, more than once per week 9 (53%) 8 (62%) 10 (83%) 2. Do you ever have any accidental leakage of liquid stool? 1.000 0.774 No 9 (53%) 7 (54%) 6 (50%) Yes, less than once per week 6 (35%) 4 (31%) 3 (25%) Yes, more than once per week 2 (12%) 2 (15%) 3 (25%) 3. How often do you open your bowels? 0.940 0.868 1–3 times per day 6 (35%) 5 (38%) 4 (33%) 4–7 times per day 8 (47%) 5 (38%) 5 (42%) > 7 times per day 2 (12%) 1 (8%) 3 (25%) < 1 time per day 1 (6%) 2 (15%) 0 (0%) 4. Do you ever have to open your bowels again within one hour of the last bowel opening? 0.132 0.140 No 1 (6%) 0 (0%) 1 (8%) Yes, less than once per week 4 (24%) 7 (54%) 0 (0%) Yes, more than once per week 12 (71%) 6 (46%) 11 (92%) 5. Do you ever have such a strong urge to open your bowels that you have to rush to the toilet? 0.645 0.202 No 5 (29%) 2 (15%) 1 (8%) Yes, less than once per week 6 (35%) 7 (54%) 3 (25%) Yes, more than once per week 6 (35%) 4 (31%) 8 (67%) Total LARS score 26.5 (21.9–31.1) 29.5 (25.9–33.1) 33.0 (28.0–38.0) 0.320 0.051 Overall, how much does bowel function affect your quality of life? 0.681 0.129 None 1 (6%) 3 (23%) 3 (25%) Low 8 (47%) 5 (38%) 1 (8%) Moderate 5 (29%) 3 (23%) 5 (42%) High 3 (18%) 2 (15%) 3 (25%) Values are presented as number (%) or mean with a 95% confidence interval. LSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; LARS, low anterior re- section syndrome. a LSC group vs ESC group; b LSC group vs AL group. a late stoma closure vs early stoma closure group; b late stoma closure vs anastomotic leakage group. * P < 0.05. EORTC QLQ-CR29 No differences were observed between the three groups in the relevant outcomes: abdominal pain, buttock pain, bloating, blood and mucus in stool, flatulence, and faecal incontinence. However, the mean stool frequency was significantly higher in the AL group compared to the LSC group (AL 44.4 vs. LSC 29.4; p = 0.041). Mean anxiety scores were significantly lower in the ESC and AL groups compared to the LSC group (ESC 69.2 and AL 63.9 vs LSC 86.3; p = 0.041 for both comparisons) (Table 4 ). Table 4 European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR29 questionnaire results in the three groups Characteristic LSC group ESC group AL group P-value a P-value b Urinary frequency 17.6 (9.5–25.8) 21.8 (6.1–37.5) 27.8 (12.3–42.3) 0.643 0.255 Urinary incontinence 5.9 (0-11.8) 20.5 (4.7–36.4) 19.4 (4.1–34.8) 0.084 0.094 Dysuria 0 10.3 (0-21.6) 5.6 (0-16.3) 0.066 0.201 Abdominal pain 9.8 (0.7–18.9) 10.3 (1.8–18.8) 11.1 (1.7–20.5) 0.945 0.842 Buttock pain 13.7 (0-28.7) 12.8 (1.3–24.4) 30.6 (8.3–52.8) 0.922 0.203 Bloating 19.6 (8.9–30.4) 20.5 (11.9–29.1) 27.8 (16.7–38.9) 0.902 0.304 Blood and mucus in stool 2.0 (0-5.8) 6.4 (0.7–12.2) 8.3 (0-17.7) 0.208 0.221 Dry mouth 7.8 (1.1–14.6) 10.3 (0-25.5) 5.6 (0-12.8) 0.782 0.656 Hair loss 3.9 (0–9.0) 0 5.6 (0-12.6) 0.087 0.725 Taste 2.0 (0-5.6) 7.7 (0-18.3) 0 0.321 0.220 Flatulence 47.1 (31.0-63.1) 41.0 (26.3–55.8) 50.0 (32.7–67.3) 0.573 0.797 Faecal incontinence 21.6 (11.9–31.3) 25.6 (10.7–40.6) 19.4 (6.8–32.1) 0.654 0.791 Sore skin 15.7 (5.7–25.6) 23.1 (9.8–36.3) 38.9 (13.1–64.7) 0.379 0.091 Stool frequency 29.4 (20.5–38.4) 35.9 (21.2–50.6) 44.4 (32.1–56.8) 0.458 0.041* Embarrassment 5.9 (0–12.0) 23.1 (4.7–41.4) 19.4 (0.3–38.6) 0.087 0.174 Stoma care problems, N = 16 7.4 (0-15.7) 0 0 NA NA Impotence, N = 26 61.5 (40.2–82.8) 66.7 (33.3–100.0) 47.6 (19.2–76.0) 0.798 0.439 Dyspareunia, N = 11 25 (9.7–40.3) 0 25 (0-54.9) < 0.001* 1.000 Anxiety 86.3 (76.6–96.0) 69.2 (55.7–82.8) 63.9 (45.3–82.5) 0.041* 0.041* Weight 88.2 (80.5–96.0) 94.9 (84.8-104.9) 88.9 (79.9–97.9) 0.294 0.913 Body image 90.2 (84.7–95.7) 83.8 (71.8–95.8) 78.7 (65.5–91.9) 0.350 0.118 Sexual interest (males), N = 26 59.0 (40.0-77.9) 50.0 (18.0–82.0) 42.9 (25.3–60.5) 0.625 0.235 Sexual interest (females), N = 12 25 (9.7–40.3) 8.3 (0-23.8) 16.7 (0-34.6) 0.116 0.488 Sexual interest (combined), N = 38 51.0 (34.4–67.6) 33.3 (9.5–57.1) 33.3 (18.6–48.0) 0.224 0.124 Values are presented as mean with a 95% confidence interval. LSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; NA, not available. a LSC group vs ESC group; b LSC group vs AL group. * P < 0.05. The figure was created using Canva (www.canva.com). DISCUSSION To our knowledge, this study is the first to combine objective anorectal measurements and subjective HRQoL assessments when comparing three groups of rectal cancer patients: patients with late reversal of diverting loop ileostomy (> 3 months), patients with early reversal of diverting loop ileostomy (8–10 days), and those with anastomotic leakage with a preserved anastomosis without a defunctioning stoma. The present study showed that patients in the ESC and AL group had significantly lower pressures in anorectal manometry compared to the LSC group. It could be hypothesized, that early stoma closure results in a shorter period of anal sphincter inactivity compared to late closure, potentially leading to better preservation of anal canal strength. Therefore, we expected the ESC group to exhibit higher manometric pressures. However, our results show the opposite, but without any significant impact on the LARS reported. We found that the ESC group demonstrated higher volumes in the rectal sensation test compared to the other two groups; however, the differences were not statistically significant. A reduced rectal sensibility is advantageous, as it allows the bowel to accommodate larger volumes before triggering the urge to defecate [ 30 ]. Additionally, fewer individuals in the ESC group reported needing another bowel movement within one hour of their last movement (LARS score question 4), but the differences were not statistically significant. These findings suggest that early reversal of diverting loop ileostomy may lead to reduced neorectal hypersensation and improved bowel emptying, which is beneficial for patients in daily life. Furthermore, early reversal seems to enable faster adaptation to the new reservoir function in the bowel, with increased capacity, which is an argument for early reversal. In contrast, the finding of reduced pressures in the manometry serves as a counterargument. When evaluating LARS, we found that the percentage of individuals who answered “Yes, more than once per week”, which is the answer that gives the most points in each question, was highest among those in the AL group for all five questions. Furthermore, in the EORTC QLQ-CR29 questionnaire, stool frequency was significantly higher in the AL group than in the LSC group. This is consistent with the expectation that patients with anastomotic leakage experience more and worse bowel function, as has been reported in previous studies [ 22 , 23 , 31 ]. We found no statistically significant differences in the LARS scores between the groups, except for controlling flatus. However, we found that the mean value for the total LARS score in the LSC group was 26.5, which is consistent with minor LARS, whereas, in the ESC group and the AL groups, the total LARS scores were 29.5 and 33, respectively, which are consistent with major LARS; however, the differences were not statistically significant. A systematic review found that in six out of the eleven included studies, a longer time to stoma closure increased the risk of major LARS [ 13 ]. In contrast, others found that the interval from the construction of the ileostomy to its reversal does not seem to be associated with the degree of LARS [ 17 , 32 ]. The present study also showed no difference in the overall impact of bowel function on HRQoL between the three groups. Our findings are consistent with previous research, including one observational study [ 33 ] and two RCTs [ 21 , 34 ], indicating that the timing of the diverting ileostomy closure does not significantly influence long-term HRQoL in rectal cancer patients. Current research is inconclusive regarding the correlation between the timing of the reversal of diverting loop ileostomy and its long-term impact on bowel function and HRQoL, and further investigation is needed. A key strength of the present study is that objective measures (anorectal physiological tests) were obtained for all participants, combined with a 100% response rate for self-reported outcomes (questionnaires), except for a few specific items. Since the same doctor (PF) performed all anal physiological examinations, this helps ensure consistency in the method and can contribute to reduced intra-observer variability. Nevertheless, it did not correspond to the reported outcomes from the patients and might be regarded as a bad outcome measure for bowel function. An essential limitation of the present study is its small population; only 42 out of 124 eligible participants agreed to participate, which may be associated with a risk of selection bias. Additionally, the small study population increases statistical uncertainty and creates a risk of wrong sample size bias. The cross-sectional study design is another limitation, as all participants only completed questionnaires and underwent anorectal manometry once at different time points following surgery. The present study design could have been improved by including objective and patient-reported measurements of bowel function preoperatively, at three months, one year, and three years postoperatively, along with continuous questionnaires. This would have made it a longitudinal study, allowing investigation of changes in bowel function and HRQoL over time. However, it can be debated whether the preoperative bowel function should be compared to the postoperative bowel function, as the presence of rectal cancer before surgery may affect anorectal function. Another limitation of this study is the use of the EORTC QLQ-CR29 questionnaire, which has only been linguistically validated in Danish and has not yet been fully psychometrically validated in a structured study for use in the Danish population. The questionnaire may not fully capture all aspects of HRQoL or reflect the experiences of this patient group within the Danish population, which could limit its generalizability. However, a study accepting the validity of the Danish version of EORTC QLQ-CR38 suggests that the EORTC QLQ-CR29 is a valid instrument [ 35 ]. Furthermore, there is a risk of bias that cancer survivors who are doing better in their daily lives are more likely to participate in a study than those who experience many challenges and discomforts related to their illness. On the other hand, individuals experiencing more difficulties may be more motivated to participate in the hope of receiving help. In conclusion, this study found no clinically relevant differences in overall bowel function or HRQoL in rectal cancer patients who had their diverting loop ileostomy reversed early (8–10 days) compared to those with late reversal (> 3 months). However, significant differences were observed in anorectal physiological measurements among the three groups. Furthermore, a non-significant difference indicating impaired anorectal function was noted in patients with anastomotic leakage. The physiological findings did not correlate with the patients' reported symptoms, raising questions about the reliability of anorectal manometry as a tool for evaluating anorectal function in this patient population. Declarations Ethics statements This study followed the ethical principles of the Declaration of Helsinki. Consent to participate: All participants gave written informed consent before inclusion. Competing Interests: The authors have no competing interests to declare. Funding: This work was supported by the Postdoctoral Foundation of the Region of Southern Denmark and the cancer program “Vejle Sygehus – Patienternes Kræftsygehus”, Denmark. Author Contribution Writing manuscript: D.P., P.F., I.A., S.M. M.E. Data collection: P.F., M.T., A.M. Statistical analysis: S.M. All authors reviewed and approved the final manuscript. Acknowledgments: Not applicable. Data Availability Data can be provided on request from the first author by email. 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Tech Coloproctol 25(7):751–760. https://doi.org/10.1007/s10151-021-02436-5 Ihnát P, Vávra P, Prokop J, Pelikán A, Ihnát Rudinská L, Penka I (2018) Functional outcome of low rectal resection evaluated by anorectal manometry. ANZ J Surg 88(6):E512–e516. https://doi.org/10.1111/ans.14207 Liu LG, Yan XB, Shan ZZ, Yan LL, Jiang CY, Zhou J et al (2017) Anorectal functional outcome following laparoscopic low anterior resection for rectal cancer. Mol Clin Oncol 6(4):613–621. https://doi.org/10.3892/mco.2017.1183 Dulskas A, Samalavicius NE (2016) Usefulness of Anorectal Manometry for Diagnosing Continence Problems After a Low Anterior Resection. Ann Coloproctol 32(3):101–104. https://doi.org/10.3393/ac.2016.32.3.101 Keane C, Park J, Öberg S, Wedin A, Bock D, O'Grady G et al (2019) Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg 106(5):645–652. https://doi.org/10.1002/bjs.11092 Podda M, Coccolini F, Gerardi C, Castellini G, Wilson MSJ, Sartelli M et al (2022) Early versus delayed defunctioning ileostomy closure after low anterior resection for rectal cancer: a meta-analysis and trial sequential analysis of safety and functional outcomes. Int J Colorectal Dis 37(4):737–756. https://doi.org/10.1007/s00384-022-04106-w Mirande MD, Bews KA, Brady JT, Colibaseanu DT, Shawki SF, Perry WR et al (2025) Does timing of ileostomy closure impact postoperative morbidity? Colorectal Dis 27(4):e70088. https://doi.org/10.1111/codi.70088 O'Sullivan NJ, Temperley HC, Nugent TS, Low EZ, Kavanagh DO, Larkin JO et al (2022) Early vs. standard reversal ileostomy: a systematic review and meta-analysis. Tech Coloproctol 26(11):851–862. https://doi.org/10.1007/s10151-022-02629-6 Dulskas A, Petrauskas V, Kuliavas J, Bickaite K, Kairys M, Pauza K et al (2021) Quality of Life and Bowel Function Following Early Closure of a Temporary Ileostomy in Patients with Rectal Cancer: A Report from a Single-Center Randomized Controlled Trial. J Clin Med 10(4). https://doi.org/10.3390/jcm10040768 Hain E, Manceau G, Maggiori L, Mongin C, Prost À, la Denise J, Panis Y (2017) Bowel dysfunction after anastomotic leakage in laparoscopic sphincter-saving operative intervention for rectal cancer: A case-matched study in 46 patients using the Low Anterior Resection Score. Surgery 161(4):1028–1039. https://doi.org/10.1016/j.surg.2016.09.037 Kim S, Kang SI, Kim SH, Kim JH (2021) The Effect of Anastomotic Leakage on the Incidence and Severity of Low Anterior Resection Syndrome in Patients Undergoing Proctectomy: A Propensity Score Matching Analysis. Ann Coloproctol 37(5):281–290. https://doi.org/10.3393/ac.2021.03.15 Jutesten H, Buchwald PL, Angenete E, Rutegård M, Lydrup ML (2022) High Risk of Low Anterior Resection Syndrome in Long-term Follow-up After Anastomotic Leakage in Anterior Resection for Rectal Cancer. Dis Colon Rectum 65(10):1264–1273. https://doi.org/10.1097/dcr.0000000000002334 Marinatou A, Theodoropoulos GE, Karanika S, Karantanos T, Siakavellas S, Spyropoulos BG et al (2014) Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? A case-matched study. Dis Colon Rectum 57(2):158–166. https://doi.org/10.1097/dcr.0000000000000040 Mongin C, Maggiori L, Agostini J, Ferron M, Panis Y (2014) Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study. Int J Colorectal Dis 29(4):459–467. https://doi.org/10.1007/s00384-014-1833-y Ellis CT, Maykel JA (2021) Defining Anastomotic Leak and the Clinical Relevance of Leaks. Clin Colon Rectal Surg 34(6):359–365. https://doi.org/10.1055/s-0041-1735265 Ellebæk MB, Perdawood SK, Steenstrup S, Khalaf S, Kundal J, Möller S et al (2023) Early versus late reversal of diverting loop ileostomy in rectal cancer surgery: a multicentre randomized controlled trial. Sci Rep 13(1):5818. https://doi.org/10.1038/s41598-023-33006-4 Ellebaek MB, Rahr HB, Boye S, Fristrup C, Qvist N (2019) Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study. Colorectal Dis 21(12):1387–1396. https://doi.org/10.1111/codi.14781 Staller K (2015) Role of Anorectal Manometry in Clinical Practice. Curr Treat Options Gastroenterol 13(4):418–431. https://doi.org/10.1007/s11938-015-0067-6 Re AD, Tooza S, Diab J, Karam C, Sarofim M, Ooi K et al (2023) Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life. Ann Coloproctol 39(5):395–401. https://doi.org/10.3393/ac.2022.00073.0010 Jiménez-Rodríguez RM, Segura-Sampedro JJ, Rivero-Belenchón I, Díaz Pavón JM, García Cabrera AM, Monchul V, J. M., et al (2017) Is the interval from surgery to ileostomy closure a risk factor for low anterior resection syndrome? Colorectal Dis 19(5):485–490. https://doi.org/10.1111/codi.13524 Meyer VM, Bosch N, van der Heijden JAG, Kalkdijk-Dijkstra AJ, Pierie J, Beets GL et al (2024) Long-Term Functional Outcome After Early vs. Late Stoma Closure in Rectal Cancer Surgery: Sub-analysis of the Multicenter FORCE Trial. J Gastrointest Cancer 55(3):1266–1273. https://doi.org/10.1007/s12029-024-01062-2 Ahmadi-Amoli H, Rahimi M, Abedi-Kichi R, Ebrahimian N, Hosseiniasl SM, Hajebi R et al (2023) Early closure compared to late closure of temporary ileostomy in rectal cancer: a randomized controlled trial study. Langenbecks Arch Surg 408(1):234. https://doi.org/10.1007/s00423-023-02934-0 Thaysen HV, Jess P, Laurberg S, Groenvold M (2012) Validation of the Danish version of the disease specific instrument EORTC QLQ-CR38 to assess health-related quality of life in patients with colorectal cancer. Health Qual Life Outcomes 10:150. https://doi.org/10.1186/1477-7525-10-150 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6975954","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477746493,"identity":"9958b131-b980-4759-b016-c816edff9654","order_by":0,"name":"Ditte Reitz Petersen","email":"","orcid":"","institution":"Odense University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ditte","middleName":"Reitz","lastName":"Petersen","suffix":""},{"id":477746494,"identity":"cf19c1da-58f3-48c0-9316-6316b6fa8fa5","order_by":1,"name":"Pia Møller Faaborg","email":"","orcid":"","institution":"Gødstrup Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pia","middleName":"Møller","lastName":"Faaborg","suffix":""},{"id":477746495,"identity":"008100d2-6bc2-465e-8294-07637668f111","order_by":2,"name":"Issam Al-Najami","email":"","orcid":"","institution":"Odense University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Issam","middleName":"","lastName":"Al-Najami","suffix":""},{"id":477746496,"identity":"6c3567d2-3fa4-4067-93c0-b9637956782d","order_by":3,"name":"Maja Mi Thygesen","email":"","orcid":"","institution":"Odense University Hospital, Svendborg","correspondingAuthor":false,"prefix":"","firstName":"Maja","middleName":"Mi","lastName":"Thygesen","suffix":""},{"id":477746497,"identity":"f3ea85d4-80da-4dbc-944d-dfa4ab6c70cf","order_by":4,"name":"Anna Pilegaard Bjarnesen Mølstrøm","email":"","orcid":"","institution":"Odense University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"Pilegaard Bjarnesen","lastName":"Mølstrøm","suffix":""},{"id":477746498,"identity":"be91d2ff-c2b8-4ba2-a928-3df6f4aa78f9","order_by":5,"name":"Sören Möller","email":"","orcid":"","institution":"University of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Sören","middleName":"","lastName":"Möller","suffix":""},{"id":477746499,"identity":"62f3fcf0-c93b-43e1-a9f7-4083e5547761","order_by":6,"name":"Mark Bremholm Ellebaek","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYHACZiC2kGGQYGBgbDCwAYkYMPAcIKhFggeipSCNZC0fDhPWott+9rEBQ4UED79088OHMwzO58vPSN7A8OYMbi1mZ9KNExjOSPBIzjlmbLjB4LblhhtpBYxzbuDRciCN+QBjmwSPwY0EM8kHBrcNDCRyDJh5PuDRcv4ZUMs/CR77G+nffz4wOGcgP4OQlhtpzAmMDUBbJHLMGDcYHDBguAHSgs9hN54xGyQck+CRuHOmWHKGQbKBwZlnBQfn4PP++TRmiQ81NnL8s9s3fuz5Y2cg35688cGbY7i1gEECCk8ggeEAAQ3ogJ9UDaNgFIyCUTDcAQB/qFQWv2OwFQAAAABJRU5ErkJggg==","orcid":"","institution":"Odense University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mark","middleName":"Bremholm","lastName":"Ellebaek","suffix":""}],"badges":[],"createdAt":"2025-06-25 14:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6975954/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6975954/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85747738,"identity":"6ec18cd8-e39c-4b02-8151-7c9a9813fccd","added_by":"auto","created_at":"2025-07-01 09:39:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":144992,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for the study population\u003c/p\u003e\n\u003cp\u003eThe figure was created using Canva (www.canva.com).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6975954/v1/8177f9ae89f82647b2e24ddf.png"},{"id":88011131,"identity":"e5c4c8e3-7099-4c85-bc1a-01ea4aa1923e","added_by":"auto","created_at":"2025-07-31 12:02:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1139881,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6975954/v1/75d794a3-df9c-4d68-aacb-665cd569d6ed.pdf"},{"id":85747739,"identity":"71d6aed6-86c6-4923-ace2-4f1a5556c932","added_by":"auto","created_at":"2025-07-01 09:39:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":33760,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistcrosssectional.docx","url":"https://assets-eu.researchsquare.com/files/rs-6975954/v1/1f3863e618c4411fdee70e66.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eLow Anterior Resection (LAR) with Total Mesorectal Excision (TME) is the standard surgical modality for treating rectal cancers. Bowel dysfunction following LAR is a well-known problem among patients treated for rectal cancer and is referred to as low anterior resection syndrome (LARS) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Previous studies have shown a prevalence of LARS in 60\u0026ndash;90% after LAR [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The most frequently reported symptoms are faecal incontinence, fragmented bowel movements, flatus incontinence and urgency [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As a consequence of the changes in bowel function, many patients experience affected health-related quality of life (HRQoL) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRisk factors for LARS include neoadjuvant radiotherapy (RT), diverting loop ileostomy, low anastomosis and anastomotic leakage [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Neoadjuvant RT is associated with internal sphincter dysfunction and reduced capacity, which corresponds with LARS [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nerve damage and radiation-induced fibrosis may cause this [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Other studies have found that female sex is also associated with an increased risk of LARS [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, the timing of diverting ileostomy reversal may impact postoperative bowel function [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnorectal manometry is used as an objective measure of anorectal function and continence and has been shown to be impaired following LAR [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Resting anal sphincter pressure is lower in rectal cancer patients treated with LAR [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, rectal sensitivity is affected in patients following LAR, and they produce reduced volumes at first sensation and urge to defecate [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have evaluated and compared the early reversal of diverting loop ileostomy (8\u0026ndash;10 days) with the late reversal of diverting loop ileostomy (\u0026gt;\u0026thinsp;3 months), focusing primarily on stoma-related complications [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], mortality, morbidity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], HRQoL, and LARS [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These studies have shown mixed results, with no clear consensus on the optimal timing for ileostomy reversal. However, the objective anorectal function and continence measured by anorectal physiological tests, and their association with HRQoL, are not well researched when comparing early and late reversal of diverting loop ileostomy. Additionally, previous studies have found that anastomotic leakage is associated with impaired functional outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], including an increased risk of major LARS [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and reduced HRQoL [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], which may be due to inflammation [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and pelvic fibrosis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to evaluate functional and pathophysiological changes in the rectum after LAR via anal physiological examination in three different groups of rectal cancer patients: a late stoma closure (LSC) group, an early stoma closure (ESC) group, and an anastomotic leakage (AL) group. Secondly, patient-reported outcomes were compared using questionnaires, including the LARS score and EORTC QLQ-CR29.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics statements\u003c/h2\u003e \u003cp\u003e This study followed the ethical principles of the Declaration of Helsinki. Ethical approval was granted by The Regional Committees on Health Research Ethics for Southern Denmark (ID S-20150074). All participants gave written informed consent before inclusion.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThree groups of rectal cancer patients treated with LAR were compared. The LSC group served as the control group and included patients who had a diverting loop ileostomy for at least three months. The ESC group included patients who underwent reversal of diverting loop ileostomy eight to ten days after LAR. The AL group was the complication group and included patients who suffered a CT-verified anastomotic leak but were treated with preserved anastomosis following LAR. They had a delayed stoma reversal performed (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy population baseline characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLSC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eESC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAL group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale/female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (76%) / 4 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (62%) / 5 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (67%) / 4 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.5 (24.8\u0026ndash;28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.7 (26.8\u0026ndash;31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.25 (24.4\u0026ndash;29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcess alcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformance score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePS0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePS1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemoradiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays to stoma closure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118 (96\u0026ndash;162)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e212.5 (103-268.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays from stoma closure to anorectal physiological examinations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e683 (561\u0026ndash;826)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e733 (594\u0026ndash;964)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e817.5 (564-1318.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as number (%) or median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; NA, not available.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eLSC group vs ESC group; \u003csup\u003eb\u003c/sup\u003eLSC group vs AL group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStudy participants were identified among former rectal cancer patients who had previously participated in research studies from our group (N\u0026thinsp;=\u0026thinsp;279) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. All had consented to be invited to further studies based on the inclusion criteria: age\u0026thinsp;\u0026gt;\u0026thinsp;18 years, being \u0026gt;\u0026thinsp;1 and \u0026lt;\u0026thinsp;4 years post primary surgery (LAR) or reversal of diverting loop ileostomy.\u003c/p\u003e \u003cp\u003eExclusion criteria included patients who were pregnant or breastfeeding, patients who were not considered capable of following the planned examination protocol, patients who had previous major surgery in the region, and patients who had previously received radiotherapy in the area for other diseases.\u003c/p\u003e\n\u003ch3\u003eAnorectal physiological examinations \u003c/h3\u003e\n\u003cp\u003eAn expert specialist (PF) performed anorectal physiology examinations under standard conditions. Before the examination, participants fasted for two hours and emptied their urinary bladder. Anorectal manometry was conducted using the ManoScanTM Anorectal High Resolution Manometry System (Medtronic, MN, USA). Anal resting pressure, squeeze pressure, and squeeze pressure increments, as well as the rectal volume at first sensation, urge to defecate, and maximum tolerable volume, were measured three consecutive times. Results were reported as the mean value.\u003c/p\u003e \u003cp\u003eBefore the anorectal physiological examinations, a digital rectal examination, a proctoscopy, and a 3D anorectal ultrasound were performed to ensure there were no clinical signs of recurrence or other significant anorectal diseases that could affect the results. If the rectum was not empty during the digital examination, a rectal enema (Microlax\u0026reg;, McNeil, Birkeroed, Denmark) was administered. All examinations were conducted with the patient in the left lateral position. Across all groups, anorectal physiological examinations were performed approximately two years after stoma closure.\u003c/p\u003e\n\u003ch3\u003eQuestionnaires\u003c/h3\u003e\n\u003cp\u003eOn the examination day, all study participants completed the LARS score and the EORTC QLQ-CR29 questionnaires, specific for colorectal cancer and used to evaluate subjective bowel function and HRQoL.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome of this study was functional and pathophysiological changes in the neorectum following LAR assessed by anorectal physiological examinations. The secondary outcomes were patient-reported bowel dysfunction and HRQoL evaluated using the LARS score and EORTC QLQ-CR29. The LARS score was stratified by severity into three predefined groups: no LARS (0\u0026ndash;20 points), minor LARS (21\u0026ndash;29 points), and major LARS (30\u0026ndash;42 points) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical methods\u003c/h2\u003e \u003cp\u003eWe presented categorial characteristics as counts and proportions and compare these between groups using Fisher\u0026rsquo;s exact test. Numerical characteristics are presented as medians with interquartile ranges (IQR) and compared by a k-sample test for equality of medians. The LARS total score and the EORTC QLQ-CR29 scales are compared using linear regression and reported as means with a 95% confidence interval, applying bootstrapping with 1000 repetitions to take into account the non-normality of scores.\u003c/p\u003e \u003cp\u003eWe did not perform a sample size calculation as this study was an observational study on a pragmatically chosen cohort of available patients.\u003c/p\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Analyses were performed using Stata 18.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAmong the 279 potential participants from the two original studies [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], 98 individuals did not meet the inclusion criteria and were excluded because of death, cancer recurrence, or a permanent stoma performed. This left 181 eligible participants who were screened for inclusion. Subsequently, an additional 57 participants were excluded, as more than four years had elapsed since their surgery. This ensured a less diverse study population with no difference in time since stoma reversal. Ultimately, 124 participants met the inclusion criteria and were invited to participate in the study. Of these, 42 accepted participation and were included in the final analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Baseline characteristics were similar across the three groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAnorectal measurements were successfully conducted for all participants, and the overall questionnaire response rate was 100%, except for specific items in the EORTC QLQ-CR29 questionnaire regarding dyspareunia, sexual interest, and stoma care problems.\u003c/p\u003e\n\u003ch3\u003eAnorectal physiological examinations\u003c/h3\u003e\n\u003cp\u003eMedian anal resting pressure was significantly lower in the ESC and AL groups compared to the LSC group (ESC 35 mmHg and AL 28 mmHg vs. LSC 54 mmHg, p\u0026thinsp;=\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). Median squeeze pressure was lower in the ESC and AL groups as well (ESC 70 mmHg and AL 71 mmHg vs. LSC 140 mmHg; p\u0026thinsp;=\u0026thinsp;0.010 and p\u0026thinsp;=\u0026thinsp;0.004). Similarly, the median squeeze pressure increment was reduced in the ESC and AL groups (ESC 36 mmHg and AL 38 mmHg vs. LSC 72 mmHg; p\u0026thinsp;=\u0026thinsp;0.003 and p\u0026thinsp;=\u0026thinsp;0.004). In the rectal sensation test, volumes were higher in the ESC group, however, these were not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnorectal physiological examination results in the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLSC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eESC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAL group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnal manometry (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (50\u0026ndash;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (20\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (22.5\u0026ndash;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSqueeze\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (95\u0026ndash;168)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (46\u0026ndash;95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (45-81.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSqueeze pressure increment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (60\u0026ndash;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (30\u0026ndash;48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (25.5\u0026ndash;54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBallon, rectal sensation (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalloon first\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (20\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (30\u0026ndash;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.5 (20\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalloon urge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (45\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (65\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (37.5\u0026ndash;105)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalloon max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (80\u0026ndash;180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 (105\u0026ndash;179)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (72.5\u0026ndash;130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectal inhibitory reflex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as number (%) median (interquartile range).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; NA, not available.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eLSC group vs ESC group; \u003csup\u003eb\u003c/sup\u003eLSC group vs AL group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLARS scores\u003c/h2\u003e \u003cp\u003eThere were no statistically significant differences between the three groups in the LARS score, except for question 1 (regarding controlling flatus), where a significant difference was found between the LSC and ESC groups (LSC: 9 patients (53%) reported more than once per week, ESC: 8 (62%); p\u0026thinsp;=\u0026thinsp;0.050). No significant differences in the impact on overall quality of life were observed between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLow anterior resection syndrome (LARS) scores in the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLSC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eESC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAL group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Do you ever have occasions when you cannot control your flatus (wind)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.050*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, less than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, more than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Do you ever have any accidental leakage of liquid stool?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, less than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, more than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. How often do you open your bowels?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 times per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 time per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Do you ever have to open your bowels again within one hour of the last bowel opening?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, less than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, more than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Do you ever have such a strong urge to open your bowels that you have to rush to the toilet?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, less than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, more than once per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal LARS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.5 (21.9\u0026ndash;31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.5 (25.9\u0026ndash;33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.0 (28.0\u0026ndash;38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall, how much does bowel function affect your quality of life?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as number (%) or mean with a 95% confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; LARS, low anterior re- section syndrome.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eLSC group vs ESC group; \u003csup\u003eb\u003c/sup\u003eLSC group vs AL group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e late stoma closure vs early stoma closure group; \u003csup\u003eb\u003c/sup\u003e late stoma closure vs anastomotic leakage group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eEORTC QLQ-CR29\u003c/h2\u003e \u003cp\u003eNo differences were observed between the three groups in the relevant outcomes: abdominal pain, buttock pain, bloating, blood and mucus in stool, flatulence, and faecal incontinence. However, the mean stool frequency was significantly higher in the AL group compared to the LSC group (AL 44.4 vs. LSC 29.4; p\u0026thinsp;=\u0026thinsp;0.041). Mean anxiety scores were significantly lower in the ESC and AL groups compared to the LSC group (ESC 69.2 and AL 63.9 vs LSC 86.3; p\u0026thinsp;=\u0026thinsp;0.041 for both comparisons) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEuropean Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR29 questionnaire results in the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLSC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eESC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAL group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.6 (9.5\u0026ndash;25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.8 (6.1\u0026ndash;37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.8 (12.3\u0026ndash;42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.9 (0-11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.5 (4.7\u0026ndash;36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4 (4.1\u0026ndash;34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysuria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3 (0-21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6 (0-16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.8 (0.7\u0026ndash;18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3 (1.8\u0026ndash;18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.1 (1.7\u0026ndash;20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eButtock pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.7 (0-28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.8 (1.3\u0026ndash;24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6 (8.3\u0026ndash;52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBloating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.6 (8.9\u0026ndash;30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.5 (11.9\u0026ndash;29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.8 (16.7\u0026ndash;38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood and mucus in stool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 (0-5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4 (0.7\u0026ndash;12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3 (0-17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDry mouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.8 (1.1\u0026ndash;14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3 (0-25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6 (0-12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHair loss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.9 (0\u0026ndash;9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6 (0-12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 (0-5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7 (0-18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlatulence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.1 (31.0-63.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.0 (26.3\u0026ndash;55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.0 (32.7\u0026ndash;67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFaecal incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.6 (11.9\u0026ndash;31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.6 (10.7\u0026ndash;40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4 (6.8\u0026ndash;32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSore skin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.7 (5.7\u0026ndash;25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.1 (9.8\u0026ndash;36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.9 (13.1\u0026ndash;64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStool frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.4 (20.5\u0026ndash;38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.9 (21.2\u0026ndash;50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.4 (32.1\u0026ndash;56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.041*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmbarrassment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.9 (0\u0026ndash;12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.1 (4.7\u0026ndash;41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4 (0.3\u0026ndash;38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma care problems, N\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4 (0-15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpotence, N\u0026thinsp;=\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.5 (40.2\u0026ndash;82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7 (33.3\u0026ndash;100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.6 (19.2\u0026ndash;76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspareunia, N\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (9.7\u0026ndash;40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (0-54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.3 (76.6\u0026ndash;96.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.2 (55.7\u0026ndash;82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.9 (45.3\u0026ndash;82.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.041*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.041*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.2 (80.5\u0026ndash;96.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.9 (84.8-104.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.9 (79.9\u0026ndash;97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody image\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.2 (84.7\u0026ndash;95.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.8 (71.8\u0026ndash;95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.7 (65.5\u0026ndash;91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual interest (males), N\u0026thinsp;=\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.0 (40.0-77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0 (18.0\u0026ndash;82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9 (25.3\u0026ndash;60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual interest (females), N\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (9.7\u0026ndash;40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3 (0-23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7 (0-34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual interest (combined), N\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.0 (34.4\u0026ndash;67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3 (9.5\u0026ndash;57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3 (18.6\u0026ndash;48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as mean with a 95% confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLSC, late stoma closure; ESC, early stoma closure; AL, anastomotic leakage; NA, not available.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eLSC group vs ESC group; \u003csup\u003eb\u003c/sup\u003eLSC group vs AL group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eThe figure was created using Canva (www.canva.com).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo our knowledge, this study is the first to combine objective anorectal measurements and subjective HRQoL assessments when comparing three groups of rectal cancer patients: patients with late reversal of diverting loop ileostomy (\u0026gt;\u0026thinsp;3 months), patients with early reversal of diverting loop ileostomy (8\u0026ndash;10 days), and those with anastomotic leakage with a preserved anastomosis without a defunctioning stoma.\u003c/p\u003e \u003cp\u003eThe present study showed that patients in the ESC and AL group had significantly lower pressures in anorectal manometry compared to the LSC group. It could be hypothesized, that early stoma closure results in a shorter period of anal sphincter inactivity compared to late closure, potentially leading to better preservation of anal canal strength. Therefore, we expected the ESC group to exhibit higher manometric pressures. However, our results show the opposite, but without any significant impact on the LARS reported.\u003c/p\u003e \u003cp\u003eWe found that the ESC group demonstrated higher volumes in the rectal sensation test compared to the other two groups; however, the differences were not statistically significant. A reduced rectal sensibility is advantageous, as it allows the bowel to accommodate larger volumes before triggering the urge to defecate [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Additionally, fewer individuals in the ESC group reported needing another bowel movement within one hour of their last movement (LARS score question 4), but the differences were not statistically significant. These findings suggest that early reversal of diverting loop ileostomy may lead to reduced neorectal hypersensation and improved bowel emptying, which is beneficial for patients in daily life. Furthermore, early reversal seems to enable faster adaptation to the new reservoir function in the bowel, with increased capacity, which is an argument for early reversal. In contrast, the finding of reduced pressures in the manometry serves as a counterargument.\u003c/p\u003e \u003cp\u003eWhen evaluating LARS, we found that the percentage of individuals who answered \u0026ldquo;Yes, more than once per week\u0026rdquo;, which is the answer that gives the most points in each question, was highest among those in the AL group for all five questions. Furthermore, in the EORTC QLQ-CR29 questionnaire, stool frequency was significantly higher in the AL group than in the LSC group. This is consistent with the expectation that patients with anastomotic leakage experience more and worse bowel function, as has been reported in previous studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe found no statistically significant differences in the LARS scores between the groups, except for controlling flatus. However, we found that the mean value for the total LARS score in the LSC group was 26.5, which is consistent with minor LARS, whereas, in the ESC group and the AL groups, the total LARS scores were 29.5 and 33, respectively, which are consistent with major LARS; however, the differences were not statistically significant.\u003c/p\u003e \u003cp\u003eA systematic review found that in six out of the eleven included studies, a longer time to stoma closure increased the risk of major LARS [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In contrast, others found that the interval from the construction of the ileostomy to its reversal does not seem to be associated with the degree of LARS [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study also showed no difference in the overall impact of bowel function on HRQoL between the three groups. Our findings are consistent with previous research, including one observational study [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and two RCTs [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], indicating that the timing of the diverting ileostomy closure does not significantly influence long-term HRQoL in rectal cancer patients.\u003c/p\u003e \u003cp\u003eCurrent research is inconclusive regarding the correlation between the timing of the reversal of diverting loop ileostomy and its long-term impact on bowel function and HRQoL, and further investigation is needed.\u003c/p\u003e \u003cp\u003eA key strength of the present study is that objective measures (anorectal physiological tests) were obtained for all participants, combined with a 100% response rate for self-reported outcomes (questionnaires), except for a few specific items. Since the same doctor (PF) performed all anal physiological examinations, this helps ensure consistency in the method and can contribute to reduced intra-observer variability. Nevertheless, it did not correspond to the reported outcomes from the patients and might be regarded as a bad outcome measure for bowel function.\u003c/p\u003e \u003cp\u003eAn essential limitation of the present study is its small population; only 42 out of 124 eligible participants agreed to participate, which may be associated with a risk of selection bias. Additionally, the small study population increases statistical uncertainty and creates a risk of wrong sample size bias.\u003c/p\u003e \u003cp\u003eThe cross-sectional study design is another limitation, as all participants only completed questionnaires and underwent anorectal manometry once at different time points following surgery. The present study design could have been improved by including objective and patient-reported measurements of bowel function preoperatively, at three months, one year, and three years postoperatively, along with continuous questionnaires. This would have made it a longitudinal study, allowing investigation of changes in bowel function and HRQoL over time. However, it can be debated whether the preoperative bowel function should be compared to the postoperative bowel function, as the presence of rectal cancer before surgery may affect anorectal function.\u003c/p\u003e \u003cp\u003eAnother limitation of this study is the use of the EORTC QLQ-CR29 questionnaire, which has only been linguistically validated in Danish and has not yet been fully psychometrically validated in a structured study for use in the Danish population. The questionnaire may not fully capture all aspects of HRQoL or reflect the experiences of this patient group within the Danish population, which could limit its generalizability. However, a study accepting the validity of the Danish version of EORTC QLQ-CR38 suggests that the EORTC QLQ-CR29 is a valid instrument [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, there is a risk of bias that cancer survivors who are doing better in their daily lives are more likely to participate in a study than those who experience many challenges and discomforts related to their illness. On the other hand, individuals experiencing more difficulties may be more motivated to participate in the hope of receiving help.\u003c/p\u003e \u003cp\u003eIn conclusion, this study found no clinically relevant differences in overall bowel function or HRQoL in rectal cancer patients who had their diverting loop ileostomy reversed early (8\u0026ndash;10 days) compared to those with late reversal (\u0026gt;\u0026thinsp;3 months). However, significant differences were observed in anorectal physiological measurements among the three groups. Furthermore, a non-significant difference indicating impaired anorectal function was noted in patients with anastomotic leakage.\u003c/p\u003e \u003cp\u003eThe physiological findings did not correlate with the patients' reported symptoms, raising questions about the reliability of anorectal manometry as a tool for evaluating anorectal function in this patient population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics statements\u003c/strong\u003e \u003cp\u003eThis study followed the ethical principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate:\u003c/strong\u003e \u003cp\u003eAll participants gave written informed consent before inclusion.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests:\u003c/strong\u003e \u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work was supported by the Postdoctoral Foundation of the Region of Southern Denmark and the cancer program \u0026ldquo;Vejle Sygehus \u0026ndash; Patienternes Kr\u0026aelig;ftsygehus\u0026rdquo;, Denmark.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWriting manuscript: D.P., P.F., I.A., S.M. M.E. Data collection: P.F., M.T., A.M. Statistical analysis: S.M. All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData can be provided on request from the first author by email.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChristensen P, Im Baeten C, Esp\u0026iacute;n-Basany E, Martellucci J, Nugent KP, Zerbib F et al (2021) Managementguidelines for low anterior resection syndrome - the MANUEL project. Colorectal Dis 23(2):461\u0026ndash;475. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.15517\u003c/span\u003e\u003cspan address=\"10.1111/codi.15517\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeane C, Wells C, O'Grady G, Bissett IP (2017) Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis 19(8):713\u0026ndash;722. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.13767\u003c/span\u003e\u003cspan address=\"10.1111/codi.13767\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePieniowski EHA, Nordenvall C, Palmer G, Johar A, Tumlin Ekelund S, Lagergren P et al (2020) Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study. 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Langenbecks Arch Surg 408(1):234. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00423-023-02934-0\u003c/span\u003e\u003cspan address=\"10.1007/s00423-023-02934-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThaysen HV, Jess P, Laurberg S, Groenvold M (2012) Validation of the Danish version of the disease specific instrument EORTC QLQ-CR38 to assess health-related quality of life in patients with colorectal cancer. Health Qual Life Outcomes 10:150. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1477-7525-10-150\u003c/span\u003e\u003cspan address=\"10.1186/1477-7525-10-150\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Rectal Neoplasms, Manometry, Low Anterior Resection Syndrome, Quality of Life","lastPublishedDoi":"10.21203/rs.3.rs-6975954/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6975954/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: This study aimed to characterize bowel function, anorectal physiology, and health-related quality of life (HRQoL) in rectal cancer patients following low anterior resection (LAR), comparing three groups: a control group with late stoma closure (LSC) (\u0026gt;3 months), an early stoma closure group (ESC) (8-10 days), and an anastomotic leakage group (AL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This cross-sectional study evaluated anorectal function using anorectal manometry. Bowel function and HRQoL were assessed using the low anterior resection syndrome (LARS) score and the EORTC QLQ-CR29 questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Of 124 eligible participants, 42 accepted participation. ESC and AL had significantly lower median (IQR) pressures in mmHg compared to LSC: rest: LSC: 54 (50-77), ESC: 35 (20-45), AL: 28 (22.5-33), p=0.001, p\u0026lt;0.001; squeeze: LSC: 140 (95-168), ESC: 70 (46-95), AL: 71 (45-81.5), p=0.010, p=0.004; squeeze pressure increments: LSC: 72 (60-89), ESC: 36 (30-48) and AL: 38 (25.5-54), p=0.003, p=0.004. ESC showed higher but non-significant median (IQR) volumes in ml: first sensation: LSC: 30 (20-40), ESC: 40 (30-50), p=0.153; urge: LSC: 55 (45-100), ESC: 90 (65-100) p=0.269; max: LSC: 110 (80-180), ESC: 142 (105-179), p=0.713. No differences in mean (95% CI) total LARS scores were observed: LSC: 26.5 (21.9-31.1), ESC: 29.5 (25.9-33.1), AL: 33.0 (28.0-38.0), p=0.320, p=0.051. Mean (95% CI) stool frequency was significantly higher in AL: 44.4 (32.1-56.8) compared to LSC: 29.4 (20.5-38.4), p=0.041. No differences in HRQoL were observed between the groups (p=0.681, p=0.129).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: No differences in anorectal function and HRQoL were observed between early and late reversal of diverting loop ileostomy.\u003c/p\u003e","manuscriptTitle":"Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 09:38:22","doi":"10.21203/rs.3.rs-6975954/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74c0024e-c680-4893-a36d-9a2b56b5c6b6","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-31T11:54:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-01 09:38:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6975954","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6975954","identity":"rs-6975954","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}