Impact of Low Anterior Resection Syndrome on Quality of Life in Colorectal Cancer Patients

Overview

This systematic review and meta-analysis evaluated the impact of low anterior resection syndrome (LARS) on health-related quality of life (HRQOL) in colorectal cancer patients using the LARS score and EORTC QLQ-C30 questionnaire. The study found that major LARS significantly impairs multiple HRQOL domains compared to minor or no LARS, highlighting the importance of bowel dysfunction assessment post-surgery.

Background

Colorectal cancer is a leading cause of cancer morbidity and mortality worldwide, with surgical resection being the primary curative treatment. Postoperative bowel dysfunction, particularly low anterior resection syndrome (LARS), is common after sphincter-preserving rectal cancer surgeries and can include symptoms like incontinence, urgency, and clustering. LARS has been associated with diminished HRQOL, but prior data have been inconsistent. The LARS score and EORTC QLQ-C30 are validated tools commonly used to assess bowel dysfunction and quality of life, respectively.

Data Highlights

Key Findings

• Major LARS occurs in approximately 44% of patients one year after sphincter-preserving rectal cancer surgery.
• Major LARS is associated with significant reductions in global health status and all functional domains of HRQOL measured by EORTC QLQ-C30.
• Symptoms of LARS include flatus and liquid stool incontinence, urgency, clustering, and increased bowel frequency.
• Risk factors for developing major LARS include female sex, total mesorectal excision, neoadjuvant/adjuvant chemoradiotherapy, low anastomosis, and postoperative complications.
• The LARS score is a validated, simple tool for assessing bowel dysfunction severity post colorectal surgery.
• Assessment of LARS severity can guide preoperative counseling and postoperative management to improve patient quality of life.

Clinical Implications

Clinicians should routinely assess bowel dysfunction using the LARS score in colorectal cancer patients after sphincter-preserving surgery to identify those at risk of impaired quality of life. Understanding the severity of LARS can inform targeted interventions and supportive care to mitigate its impact on physical, emotional, and social functioning. Preoperative counseling should include discussion of potential bowel dysfunction and its effects on HRQOL to set realistic expectations.

Conclusion

Low anterior resection syndrome significantly compromises multiple domains of health-related quality of life in colorectal cancer patients following sphincter-preserving surgery. Systematic assessment and management of LARS are essential to optimize long-term patient outcomes.

References

1. Colorectal Cancer Statistics 2020 -- Global Burden
2. Surgical Management of Colorectal Cancer -- Standard of Care
3. Bowel Dysfunction After Colorectal Surgery -- Clinical Overview
4. Low Anterior Resection Syndrome Definition and Prevalence
5. Meta-analysis on LARS Incidence -- 44% at 1 Year
6. Risk Factors for LARS -- Clinical Studies
7. Impact of LARS on Quality of Life -- Conflicting Data
8. Systematic Review on Bowel Dysfunction and HRQOL
9. LARS Score Development and Validation
10. EORTC QLQ-C30 Questionnaire -- HRQOL Assessment Tool
11. PRISMA and AMSTAR Guidelines for Systematic Reviews