Low anterior resection syndrome after sphincter-preserving surgery for rectal cancer: predictive factors and impact on perceived functional satisfaction

Sphincter-preserving surgery (SPS) for rectal cancer poses challenges in balancing oncological safety with postoperative function. This study aimed to evaluate the prevalence and determinants of Low Anterior Resection Syndrome (LARS) and to examine its association with the Perceived Functional Satisfaction (Binary Assessment) following SPS. A retrospective cohort analysis was conducted among 42 patients who underwent intersphincteric resection (ISR), ultra-low anterior resection (ULAR), or low anterior resection (LAR) for rectal adenocarcinoma between July 2019 and October 2024, and completed the LARS questionnaire. Associations between LARS severity and demographic, clinical, surgical, and pathological variables were assessed. Major LARS was observed in 52.38% of patients, occurring more frequently after ISR and ULAR (64.2%). Despite higher LARS severity, Perceived Functional Satisfaction remained preserved in 73.81% of patients. Major LARS was significantly associated with tumour proximity to the anal verge (p = 0.0265) and the SPS type (p = 0.0488). SPS achieved favourable oncological outcomes with preserved functional satisfaction. Despite a higher prevalence of LARS, Perceived Functional Satisfaction remained preserved in a substantial proportion of patients. This discordance between symptom burden and perceived satisfaction highlights the potential influence of population-specific dietary and bowel habits and underscores the need for culturally adapted functional assessment tools in rectal cancer survivorship.