Understanding the Discordance between Low Anterior Resection Syndrome Scores and Bowel-Related Quality of Life: a Secondary Analysis of a Multicenter Trial.

BACKGROUND: Low anterior resection syndrome affects most individuals following rectal cancer surgery; however, symptom severity does not always correlate with bowel-related quality of life impairment. OBJECTIVE: To characterize the discordance between low anterior resection syndrome and bowel-related quality of life scores and to identify clinical factors and low anterior resection syndrome symptoms most strongly correlated with bowel-related quality of life impairment. DESIGN: Secondary analysis of a completed multicenter, pan-Canadian randomized controlled trial. SETTINGS: Five Canadian hospitals. PATIENTS: Adults who had undergone a restorative proctectomy for rectal cancer with ileostomy closure. MAIN OUTCOME MEASURES: Patient-reported outcomes were measured at 6months after ileostomy closure, including the low anterior resection syndrome score, bowel-related quality of life, general quality of life, and depression/anxiety. RESULTS: In total, 135 patients were included. Among patients with major low anterior resection syndrome (n = 82), 61.0% had bowel-related quality of life impairment and 39.0% had no bowel-related quality of life impairment. Patients with both major low anterior resection syndrome and bowel-related quality of life impairment were more likely to still be working compared to those without bowel-related quality of life impairment (66.0 vs 43.8%, p = 0.044). Among those with minor/no low anterior resection syndrome (n = 53), 20.8% had major bowel-related quality of life impairment. In the major low anterior resection syndrome subgroup, patients with bowel-related quality of life impairment had significantly higher mean scores of stool incontinence (2.76 vs 1.88, p = 0.001), frequency (2.48 vs 1.63, p = 0.010), and urgency (15.6 vs 14.75, p = 0.035) than those without bowel-related quality of life impairment. In the minor/no low anterior resection syndrome subgroup, patients with major bowel-related quality of life impairment had significantly higher mean scores of frequency (1.73 vs 0.95, p = 0.047) than those without bowel-related quality of life impairment. The presence of major bowel-related quality of life impairment correlated well with decreased general quality of life and increased depression/anxiety, irrespective of low anterior resection syndrome severity. LIMITATIONS: Secondary analysis with modest sample size. CONCLUSIONS: Approximately 20 to 40% of patients had discordant low anterior resection syndrome severity and bowel-related quality of life scores, the latter of which correlated better with other patient-reported outcomes. See Video Abstract.