Incidence and characterization of the anterior resection syndrome through the use of the LARS scale (low anterior resection score)

Abstract

Introduction: Recently a score (LARS) has been internationally validates that quantifies the anterior resection syndrome (ARS). The objective of this study is to know the incidence and severity of the ARS using LARS and its correlation with selected variables or risk factors.

Methods: All operated patients with anterior resection for rectal cancer between October 2007 and February 2014, with curative intention and at least one year of functionality, were sent a LARS questionnaire. The variables studied were: Age sex, time elapsed since surgery, type of surgical approach, type of anastomosis, derivative ileostomy, postoperative pelvic complication, and radiotherapy regimen.

Results: Out of 195 patients, 136 (70%) responded, and 132 responded properly. A total of 47% of the patients presented "severe" LARS and 34% did not develop quantifiable ARS. Quality of life was worse in the highest LARS scores (P=.002). In the univariate analysis, total mesorectal excision, long radiotherapy regimen and derivative stoma were associated to "severe" LARS and the use of a reservoir was associated with minor LARS. In multivariate analysis only the type of resection (P<.001) and the use of a reservoir (P=.002) were individual factors related to LARS.

Conclusions: Half of the operated patients presented high LARS score and only a third did not provide a quantifiable ARS. The overall perception of quality of life was significantly worse in patients with more severe LARS. The absence of the rectum (total mesorectal excision) and the type of anastomosis were the main factors associated with the LARS score.

Keywords: Anterior resection of rectum; Anterior resection syndrome; Escala LARS; Functional results; LARS scale; Neoplasia rectal; Rectal neoplasm; Resección anterior de recto; Resultados funcionales; Síndrome de resección anterior.