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Updated: Aug 12, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Association of symptom complexes with consequence severity in low anterior resection syndrome after intersphincteric
Bin Zhang1, Chen-Chen Zou1, Hai-Tao Ma1
1Department of Colorectal Surgery, Characteristic Medical Center of People's Liberation Army Rocket Force, Beijing, China.
Background:
The international consensus delineates 8 symptom complexes and 8 consequences for defining low anterior resection syndrome (LARS). This exploratory cross-sectional study aimed to evaluate the differential associations between symptom complexes and consequence severity after intersphincteric resection (ISR) for ultralow rectal cancer.
Methods:
Patients were enrolled ≥12 months after diverting ileostomy reversal after ISR. The severity of the consensus-defined LARS variables was assessed using a 5-point Likert scale. Participants completed questionnaires on bowel function and condition-specific quality of life (CSQoL).
Results:
A total of 174 patients were included (response rate: 85.3%). Our exploratory severity scores revealed a strong symptom-consequence correlation (rs = 0.78). All symptom complexes demonstrated significant univariate associations between LARS consequence severity, bowel function satisfaction, and CSQoL (all P <.001), although "altered stool consistency" showed uniformly weak associations. Multivariate analysis identified 4 symptom complexes that remained independently associated with adverse consequences: "emptying difficulties" (B, 2.15 [95% CI, 1.16-3.14]; P <.001), "urgency" (B, 1.55 [95% CI, 0.62-2.48]; P =.001), "variable and unpredictable bowel function" (B, 1.46 [95% CI, 0.46-2.45]; P =.004), and "repeated painful stools" (B, 1.17 [95% CI, 0.45-1.89]; P =.002). In contrast, "altered stool consistency" exhibited a near-null independent association (B, -0.03 [95% CI, -0.88 to 0.82]; P =.944).
Conclusion:
Of note, 4 specific symptom complexes, including "emptying difficulties," "urgency," "variable bowel function," and "repeated painful stools," were independently associated with adverse LARS consequences after ISR. However, "altered stool consistency" showed no such independent association, which warrants further investigation.
