Low anterior resection syndrome after transanal total mesorectal excision – a comparison with the conventional top to bottom approach

Abstract

Purpose/Background: Advances in sphincter saving procedures improved the quality of life of patients with low rectal cancer. However, many of them suffered from a varying degree of functional disturbance after surgery, which is collectively known as the low anterior resection syndrome (LARS). The prevalence of LARS after transanal total mesorectal excision (TaTME) was not well described in the literature. The aim of this study was to evaluate the prevalence and severity of LARS after TaTME and compare with the conventional transabdominal, top to bottom, approach after total mesorectal excision (TME). Methods/Interventions: All patients who underwent TME from January 2016 to April 2018 for mid to low rectal cancer were followed-up with a questionnaire. The LARS score at 3, 6 and 12 months after closure of stoma were prospectively recorded. Results/Outcome(s): A total of 84 patients responded. All had diversion stoma. 70.2% were male. 36.9% had neoadjuvant radiotherapy. 39.3% of them underwent TaTME. At 3, 6 and 12 months after closure of stoma, the median LARS score were 39.0, 34.5 & 34.0 respectively. These were significantly worse compared to those who underwent the conventional approach, 32.0 (p=0.026), 23.0 (p=0.007) & 18.0 (p=0.036). Patients who underwent TaTME did have a significantly more distal anastomosis, at a median of 4cm from the anal verge, compared to 5cm in the conventional group (p=0.002). Conclusions/Discussion: Patients after TaTME may be more prone to LARS compared to the conventional approach. This difference persisted at 1 year after stoma closure.