Understanding the patient perspective in low anterior resection syndrome: which symptoms matter most?

Low anterior resection syndrome (LARS) is a common complication of rectal resections. This study aimed to identify the symptoms that patients perceive as most bothersome, compare the symptom patterns between the early and late postoperative phases, and assess the limitations of existing scoring systems in reflecting patient distress.

A cross-sectional study was conducted with 82 patients who underwent sphincter-preserving rectal resection at the Aichi Medical University Hospital (2016-2024). A questionnaire including the LARS score, Cleveland Clinic Florida Fecal Incontinence Score (CCFIS), and original questions on bothersome symptoms and subjective severity (0-10 scale) were administered. The patients were classified into the early (≤ 2 years, n = 28) and late (> 2 years, n = 54) postoperative groups.

Clustering was the most frequently reported symptom in both the early (67.9%) and late (51.9%) phases. The median CCFIS was lower in the late group (6 [0-18] vs. 3.5 [0-17], p = 0.045), while no significant differences were observed in LARS scores (33 [12-39] vs. 29.5 [0-36], p = 0.127) or subjective severity (4 [0-9] vs. 3 [0-10], p = 0.588). One-third of the patients with severe clustering were not classified as having "major LARS."

Clustering, which is often underestimated by composite scores, remained the most distressing and persistent symptom, emphasizing the need for symptom-specific evaluation in LARS.