Functional Outcomes After Rectal ESD: A Retrospective Evaluation of Low Anterior Resection Syndrome

Endoscopic submucosal dissection (ESD) is increasingly preferred as an alternative to surgery and as an organ-preserving method for the treatment of rectal lesions. However, its impact on bowel function-particularly the development of low anterior resection syndrome (LARS)-remains poorly understood. This study aimed to evaluate the incidence of LARS following rectal ESD and to identify associated clinical and pathological factors.

Data from 118 patients who underwent rectal ESD between January 2018 and December 2024 were retrospectively analyzed. Demographic characteristics, lesion location and size, histopathological findings, and LARS scores were recorded. All procedures were performed by the same experienced colorectal surgeon. For functional assessment, patients were contacted by telephone, and the LARS score was administered.

Of the patients included in the study, 60.9% were male, with a mean age of 68.2 ± 11.0 years. In total, 93.2% of lesions were located in the rectum, while 6.8% were located in the anal canal or anorectal junction. The mean lesion size was 5.04 ± 3.19 cm. Lymphovascular invasion was detected in four patients. Minor LARS was observed in 3.4% (n = 4) of cases, and no cases of major LARS were identified. All patients with LARS had adenomas located in the lower rectum containing high-grade dysplasia.

The incidence of LARS after rectal ESD is low and limited to minor symptoms. Lesion location, size, and dysplasia grade may influence LARS development. These findings support ESD as a functionally safe treatment approach. Further validation in larger, prospective studies is warranted.

This study was a retrospective observational analysis.