Long-term Changes in Low Anterior Resection Syndrome in Survivors of Rectal Cancer: Longitudinal Follow-up of a Randomized Controlled Trial

BACKGROUND: Postoperative bowel dysfunction, also known low anterior resection syndrome, is common in rectal cancer survivors and significantly impacts quality of life. Although long-term longitudinal follow-up is lacking, improvement of the syndrome is commonly believed to happen only within the first two years. OBJECTIVE: This study aims to depict the longitudinal evolvement of low anterior resection syndrome beyond 3 years and explores factors associated with the change. DESIGN: Longitudinal long-term follow-ups were performed for the single center with the largest cohort within the multi-center FOWARC randomized controlled trial. SETTING: A quaternary referral center. PATIENTS: Individuals diagnosed with rectal cancer who received long-course neoadjuvant chemotherapy or chemoradiotherapy, followed by sphincter-preserving radical proctectomy. MAIN OUTCOME MEASUREMENTS: Change of low anterior resection syndrome score and stoma status. RESULTS: Of the 220 patients responding to the first follow‐up at a median of 39 months, 178 (80.9%) responded to the second follow-up after a median of 83 months. During the interval, mean low anterior resection syndrome score improved from 29.5 (95% confidence interval [CI] 28.3–30.7) to 18.6 (95% CI 16.6–20.6). 56 (31.5%) patients reported improvement from major to no/minor severity, and 6 (3.4%) patients had new stoma due to severe bowel dysfunction. Neoadjuvant radiation (p = 0.016) was independently and negatively associated with improvement of the score. LIMITATIONS: Loss of follow-up during the long-term follow-ups. CONCLUSION: Most rectal cancer survivors with low anterior resection syndrome continued to improve beyond 3 years after proctectomy. Neoadjuvant radiation was negatively associated with long-term improvement of low anterior resection syndrome. See Video Abstract .