LAUSR

Thanks to unprecedented advancements made in the management of rectal cancer, we are witnessing an ever-increasing incidence of Low Anterior Resection Syndrome (LARS), which is probably the most debilitating long-term complication of rectal cancer surgery, yet it remains poorly managed and not fully understood by follow-up clinicians. For this reason, we aimed to identify the incidence and perioperative factors predicting LARS severity to enhance prevention and care. Observational cohort study was carried out on patients who underwent open, minimally invasive, and those managed with wait-and-watch (W&W) strategy between 2013 and 2024. Preoperative, intraoperative, and postoperative data were retrieved from our institution's electronic database. The LARS score was calculated based on phone questionnaires and correlated to clinicopathological, operative, and imaging variables. Descriptive and comparative analyses, including Cox proportional hazards and ROC curve analysis, was performed using XLSTAT. 573 patients were included for comparison. LARS was present in 43% of patients, with 28% of patients having major LARS. In W&W patients, LARS incidence was 50%. On multivariate analysis LARS severity was significantly correlated with smoking status, length of rectal stump and radiotherapy dose on the sphincter complex. Preoperative pelvimetric studies were not associated with an increase in LARS severity. Robotic versus open surgery were found similar in terms of LARS incidence and severity. LARS is a common long-term complication of rectal cancer surgery, with one-in-two patients experiencing some degree of LARS and nearly 30% facing major LARS. This data supports prehabilitation and aids decision-making between ultralow anastomosis and permanent stoma.