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.

BACKGROUND: After sphincter-saving operation for rectal cancer, the impact of anastomotic leakage on function has been well studied. The purpose of the present work was to assess the influence of symptomatic and asymptomatic anastomotic leakage on bowel function and health-related quality of life using the Low Anterior Resection Syndrome score and the disease-specific questionnaire European Organization for Research and Treatment of Quality of Life Questionnaire for Colorectal Cancer.

METHODS: The study was a case-matched study with multiple controls per case in a variable ratio from a prospectively maintained database conducted at a tertiary, colorectal operation referral center. A total of 46 patients with postoperative anastomotic leakage (symptomatic, n = 23, asymptomatic, n = 23) after laparoscopic, sphincter-saving operative intervention for rectal cancer were matched with all available patients without anastomotic leakage (control group, n = 89) using the following criteria: age, sex, type of neoadjuvant treatment, and type of anastomosis. The Low Anterior Resection Syndrome score and European Organization for Research and Treatment of Quality of Life Questionnaire for Colorectal Cancer were submitted to all included patients. The Low Anterior Resection Syndrome scores were categorized into 3 categories (no Low Anterior Resection Syndrome, minor Low Anterior Resection Syndrome, and major Low Anterior Resection Syndrome).

RESULTS: Mean follow-up after stoma closure was 46 ± 26 months. Median (interquartile range) Low Anterior Resection Syndrome score for all included patients was 27 (16-36). Patients with symptomatic anastomotic leakage had impaired Low Anterior Resection Syndrome score: median 30 (23-39) vs 27 (15-34) in the control group (P = .02), with no Low Anterior Resection Syndrome in 4% (vs 31%), minor Low Anterior Resection Syndrome in 52% (vs 52%), and major Low Anterior Resection Syndrome in 44% (vs 17%) (P = .004). No difference was noted between the asymptomatic anastomotic leakage group and control group for median Low Anterior Resection Syndrome score (P = .70) and Low Anterior Resection Syndrome categories (no Low Anterior Resection Syndrome, minor LARS, and major Low Anterior Resection Syndrome; P = .58). Patients with symptomatic anastomotic leakage had significantly more anorectal and urinary symptoms compared with patients with no or asymptomatic anastomotic leakage.

CONCLUSION: Symptomatic anastomotic leakage impairs function and quality of life after laparoscopic, sphincter-saving operative intervention for rectal cancer.