Association of symptom complexes with consequence severity in low anterior resection syndrome after intersphincteric resection for ultralow rectal cancer: An exploratory cross-sectional study.

Abstract

Background: The international consensus delineates eight symptom complexes and eight consequences for defining low anterior resection syndrome (LARS). This exploratory cross-sectional study aimed to evaluate differential associations of the symptom complexes with consequence severity after intersphincteric resection (ISR) for ultralow rectal cancer.

Methods: Patients were enrolled ≥12 months after diverting ileostomy reversal following ISR. The severity of the consensus-defined LARS variables was assessed using five-point Likert scales. 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 (r_s = 0.78). All symptom complexes demonstrated significant univariable associations with LARS consequence severity, bowel function satisfaction, and CSQoL (all p < 0.001), although "altered stool consistency" showed uniformly weak associations. Multivariable analysis identified four symptom complexes remained independently associated with adverse consequences: "emptying difficulties" (B = 2.15, 95% CI [1.16, 3.14], p < 0.001), "urgency" (B = 1.55, 95% CI [0.62, 2.48], p = 0.001), "variable and unpredictable bowel function" (B = 1.46, 95% CI [0.46, 2.45], p = 0.004), and "repeated painful stools" (B = 1.17, 95% CI [0.45, 1.89], p = 0.002). In contrast, "altered stool consistency" exhibited a near-null independent association (B = -0.03, 95% CI [-0.88, 0.82], p = 0.944).

Conclusion: Four 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 link, which warrants further investigation.