• Celia R Keane, Greg O'Grady, Ian P Bissett, Julian Hayes, Mike Hulme-Moir, Tim W Eglinton, Michael J Solomon, John W Lumley, John Simes, and StevensonAndrew R LARL.
• Research Fellow, Department of Surgery, University of Auckland, New Zealand Associate Professor, Department of Surgery, University of Auckland, New Zealand Professor, Department of Surgery, University of Auckland, New Zealand Consultant Colorectal Surgeon, Department of Surgery, Auckland City Hospital, New Zealand Consultant Colorectal Surgeon, Department of Surgery, Waitemata District Health Board, New Zealand Associate Professor, University of Otago, Christchurch, New Zealand Professor, Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia Consultant Colorectal Surgeon, Wesley Hospital, Brisbane, Australia Director of NHMRC Clinical Trials Centre and Sydney Catalyst Translational Research Centre, Sydney, Australia Associate Professor, Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Queensland, Australia.
• Dis. Colon Rectum. 2021 Nov 11.

BackgroundLow anterior resection syndrome has a significant impact on the quality of life in rectal cancer survivors. Previous studies comparing laparoscopic to open rectal resection have neglected bowel function outcomes.ObjectiveTo assess if there is a difference in the functional outcome between patients undergoing laparoscopic versus open resection for rectal adenocarcinoma.DesignCross-sectional prevalence of low anterior resection syndrome was assessed in a secondary analysis of the multi-center phase 3 randomized clinical trial, Australasian Laparoscopic Cancer of the Rectum Trial (ACTRN12609000663257).SettingSeven study subsites across New Zealand and Australia.PatientsParticipants were adults with rectal cancer who underwent anterior resection and had bowel continuity.Main Outcome MeasuresPostoperative bowel function was evaluated using the validated LARS score and Bowel Function Instrument.ResultsThe Australasian Laparoscopic Cancer of the Rectum Trial randomized 475 patients with T1-T3 rectal adenocarcinoma less than 15cm from the anal verge. 257 participants were eligible for, and invited to, participate in additional follow-up. 163 (63%) completed functional follow-up. Overall cross-sectional prevalence of major LARS was 49% (minor LARS 27%). There were no differences in median overall Bowel Function Instrument score nor LARS score between participants undergoing laparoscopic vs. open surgery (66 vs 67, p = 0.52; 31 vs 27, p = 0.24) at a median follow-up of 69 months.LimitationsThe major limitations are a result of conducting a secondary analysis; the likelihood of an insufficient sample size to detect a difference in prevalence between the groups and the possibility of selection bias as a subset of the randomized population was analyzed.ConclusionsBowel dysfunction affects a majority of rectal cancer patients for a significant time after the operation. In this secondary analysis of a randomized trial, surgical approach does not appear to influence the likelihood or severity of low anterior resection syndrome. See Video Abstract at http://links.lww.com/DCR/B794.Copyright © 2021 The American Society of Colon and Rectal Surgeons.

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