Patient Activation Predicts Postoperative Quality of Life Following Proctectomy Better Than Low Anterior Resection...

Bowel dysfunction occurring after low anterior resection, called low anterior resection syndrome (LARS), is common and may significantly impair patients' quality of life (QOL). Previous work has demonstrated that LARS severity does not always correlate with QOL impairment. The objective of this study is to explore whether patient activation may be a better predictor of postoperative bowel-related quality of life (BRQOL) following low anterior resection.

A prospective database of adult rectal cancer patients undergoing low anterior resection from a single high-volume university center from September 2018 to January 2023 was queried. Patients were excluded if they still had a stoma or had less than 1 year of follow-up. Included individuals were administered the study instruments at their standard surveillance visit: patient-reported BRQOL impairment, patient activation measure (PAM), and LARS score.

Overall, 82 patients were included (mean age 60.05 y [standard deviation 10.58], 67% male, 9.04 cm mean distance from anal verge [standard deviation 4.18], 50% received neoadjuvant radiotherapy, 4.49 y median follow-up (interquartile range 2.63). There were 50 (60.98%) patients with no/minor LARS and 32 (39.02%) with major LARS. High PAM was seen in 49 (59.76%). After adjusting for potential confounders, a high PAM score was associated with significantly lower odds of major BRQOL impairment (odds ratio 0.12, P = 0.01).

A higher level of patient activation can predict BRQOL following low anterior resection. These results may help patients and physicians improve shared decision-making by allowing them to identify better those for whom bowel dysfunction may have more impact on QOL.