Low anterior resection syndrome and bowel dysfunction after ovarian cancer cytoreductive surgery: a narrative review.

Post-operative bowel dysfunction is an important survivorship issue in ovarian, fallopian tube, and primary peritoneal cancer. Cytoreductive surgery often includes rectosigmoid resection, placing patients at risk for low anterior resection syndrome, in which disordered bowel function after sphincter-preserving rectal resection impairs quality of life. Symptoms may precede surgery and worsen after cytoreduction. This review aims to synthesize the available evidence on low anterior resection syndrome and post-operative bowel dysfunction after ovarian cancer cytoreductive surgery and to define research priorities. Its presentation after ovarian cancer surgery may differ from that after rectal cancer surgery because of differences in disease distribution, pelvic dissection, radiotherapy exposure, systemic therapy, stoma practice, and baseline gastrointestinal symptoms. In some ovarian cancer cohorts, constipation-predominant dysfunction has been reported and requires complementary assessment because the low anterior resection syndrome score measures different symptom domains. Candidate factors include ultra-low rectal resection, low anastomotic height, multiple bowel anastomoses, extensive pelvic dissection, autonomic nerve disruption, para-aortic lymphadenectomy, recurrent disease, stoma-related factors, and pre-existing bowel dysfunction. Evidence remains largely observational and heterogeneous, with limitations related to inconsistent definitions, variable assessment timing, and a lack of standardized outcome measurement. Prevention should not compromise complete macroscopic tumor resection when rectosigmoid resection is oncologically required, but surgical planning should include preservation of rectal length and pelvic autonomic function when feasible, documentation of anastomotic height, and selective stoma use with restoration of continuity when appropriate. Management is largely extrapolated from the colorectal literature and should be symptom-directed, beginning with systematic assessment, stool regulation, diet, and medication, and escalating to pelvic floor rehabilitation, transanal irrigation, or specialist pelvic floor care when needed. Prospective ovarian cancer-specific studies with baseline assessment, standardized time points, and validated patient-reported outcomes are needed to estimate prevalence and guide survivorship care.