Low anterior resection syndrome in distal rectal cancer patients and its correction methods

Aim: To evaluate and compare the functional outcomes and quality of life in distal rectal cancer patients after low anterior resection with the formation of a transverse double-fold reservoir (TDFR) and without it.

Materials and Methods: The retrospective study enrolled 80 patients with distal rectal cancer: 40 patients who underwent low anterior resection with the formation of a TDFR, and 40 patients with the formation of a colorectal anastomosis (control group). The follow-up period was 10-60 months, with a median follow-up of 36 months after primary surgery. Functional outcomes were assessed at 3, 6, 12, and 24 months after stoma closure using anal manometry, balloonometry, and questionnaires including LARS Score, Wexner, and FIQL.

Results: The 5-years overall survival rate was comparable in main and control groups (85% and 79%, respectively). Rectal sensitivity threshold, urge to defecate and maximum tolerated volume were higher in the TDFR group at 3, 6, and 12 months post-operatively. Manifestations of low anterior resection syndrome (LARS) were more frequently observed in the control group. Quality of life, as assessed by the FIQL questionnaire, was significantly better in the TDFR group. The internal sphincter function was better preserved in the TDFR group, in contrast to control group.

Conclusions: The TDFR formation in patients with distal rectal cancer after low anterior resection leads to improved anal continence within 12 months postoperatively, reduction of LARS manifestations, and enhancement of quality of life for patients while maintaining oncological radicality.