Incidence and risk factors of bowel dysfunction after minimally invasive rectal cancer surgery

Abstract Purpose Bowel dysfunction after sphincter-preserving-surgery (SPS) has a negative impact on the quality of life. Wexner and low anterior resection syndrome (LARS) scores are well-established instruments for assessing postoperative bowel dysfunction. This study aimed to analyze each symptom’s incidence and risk factors based on these scores. Additionally, the discrepancies between the two scores were analyzed. Methods Between May 2018 and July 2019, 142 patients with rectal cancer who underwent SPS via a minimally invasive surgery were included in this study. A questionnaire survey using the Wexner and LARS scores was administered 2-year after SPS or diverting ileostomy closure. Results Preoperative radiotherapy (RT) was a risk factor for five subscales composing the Wexner and LARS scores. Approximately 80% of patients undergoing preoperative RT reported their life-style alterations because of bowel dysfunction. Handsewn coloanal anastomosis (HSA) was a risk factor for the three subscales of the two scores. More than 90% of the patients who underwent HSA experienced urgency and all patients suffered from clustering. Of 35 patients with minor LARS, only one had a high Wexner score, and 28 (80.0%) patients did not report lifestyle alterations. Among the patients with major LARS, 58.7% had a low Wexner score, and 21.3% never felt their lifestyle alterations. Conclusion The results of this study provide practical data to facilitate patients’ perception of potential bowel dysfunction after surgery. The discrepancies between the Wexner and LARS scores were clarified, and further efforts are required to utilize these scores in clinical practice.