Preoperative constipation is associated with major low anterior resection syndrome—a prospective cohort study
Marcus Lindsköld, Sara Strandberg, Pamela Buchwald, Marie-Louise LydrupAbstract
Introduction
Major Low Anterior Resection Syndrome (LARS) is a common complication after anterior resection for rectal cancer. This study aimed to investigate the association between preoperative bowel function and major LARS one year after surgery.
Methods
This prospective cohort study included patients who underwent anterior resection at Skåne University Hospital in Malmö, Sweden, from December 2017 to August 2024. Patient data was retrieved from the Swedish Colorectal Cancer Registry. Preoperative bowel function was assessed using the Cleveland Clinic Constipation Score, Irritable Bowel Syndrome Severity Score, St. Mark's Incontinence Score and anal manometry. Assessments were performed preoperatively and at 12 months after index surgery or defunctioning stoma reversal. The primary outcome was major LARS at 12 months. Adjusted logistic regression was used to evaluate associations between preoperative bowel function and major LARS.
Results
Out of 313 patients, ultimately 56 patients were included and 53 had complete follow-up at 12 months. Major LARS occurred in 20 (38%) patients. Higher preoperative Cleveland Clinic Constipation Score was associated with increased odds of major LARS (OR 1.42, 95% c.i. 1.15–1.93), with a weaker association for Irritable Bowel Syndrome Severity Score (OR 1.11, 95% c.i. 1.03–1.21). No associations were found for anal sphincter pressure or St. Mark's score.
Discussion
Cleveland Clinic Constipation Score and to a lesser degree Irritable Bowel Syndrome Severity Score are associated with an increased risk of major LARS one year after surgery. The findings suggest that preoperative bowel function may improve risk stratification for major LARS.