Long-Term Bowel Function After Low Anterior Resection with Delayed or Immediate Colo-anal Anastomosis for Rectal Cancer: the ACAQOL Study.

INTRODUCTION: We conducted a retrospective study of all consecutive patients operated for rectal cancer with LAR and coloanal anastomosis in our tertiary center to compare the occurrence of LAR syndrome (LARS) more than 1 year after surgery between patients treated with DCAA and those with ICAA. Secondary objectives were to compare post-operative complications at 90 days. METHODS: From 2010 to 2022, 139 patients underwent LAR (ICAA, n = 45; DCAA, n = 25) with coloanal anastomosis for rectal cancer in our department. Long-term bowel function after LAR and post-operative outcomes were compared. RESULTS: After a median follow up of 48 months, the mean LARS score in the population (36 patients) was 32 (26; 37). The mean LARS score was significantly lower in the DCAA group (29 vs. 38; p < 0.001). A statistically significant association was found between the ICAA group and the LARS score, both in univariate and multivariate analysis adjusted on sex, age, BMI and ASA score; respectively (OR Beta = 9.9 [4.1–16]; p = 0.001) and (OR Beta = 10 9.5 [4.3–16]; p = 0.0032). The complication rate 90 days following surgery was 47%. D90 Severe complications were similar between two groups (p = 0.4). CONCLUSION: Our study showed that patients who underwent LAR with DCAA for rectal cancer had a better bowel outcome with a lower LARS score and similar morbidity and mortality rates at more than one year to patients who underwent LAR with ICAA. Along with the recent literature, we consider that DCAA could be an alternative to ICAA, at least in patients who refuse a stoma, whatever the reason.