Annals of Surgical Oncology

, Volume 26, Issue 3, pp 746–755 | Cite as

Impact of Long-Course Neoadjuvant Radiation on Postoperative Low Anterior Resection Syndrome and Quality of Life in Rectal Cancer: Post Hoc Analysis of a Randomized Controlled Trial

  • Weipeng Sun
  • Ruoxu DouEmail author
  • Jiaohua Chen
  • Sicong Lai
  • Chi Zhang
  • Lei Ruan
  • Liang Kang
  • Yanhong Deng
  • Ping Lan
  • Lei WangEmail author
  • Jianping WangEmail author
Health Services Research and Global Oncology



Neoadjuvant radiation is recommended for locally advanced rectal cancer, with proven benefit in local control but not in disease-free survival. However, the impact of long-course radiation on postoperative bowel function and quality of life (QOL) remains controversial. This study aimed to investigate the impact of long-course neoadjuvant radiation on bowel function and QOL, and to identify risk factors for severe bowel dysfunction.


Patients who underwent long-course neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT) followed by radical low anterior resection for locally advanced rectal cancer were recruited from the FOWARC randomized controlled trial. Low anterior resection syndrome (LARS) score and European Organisation for Research and Treatment of Cancer (EORTC) C30/CR29 questionnaires were used to assess bowel function and QOL, respectively.


Overall, 220 patients responded after a median follow-up of 40.2 months, of whom 119 (54.1%) reported major LARS, 74 (33.6%) reported minor LARS, and 27 (12.3%) reported no LARS. Compared with the nCT group, the nCRT group reported more major LARS (64.4% vs. 38.6%, p < 0.001) and worse QOL. Long-course neoadjuvant radiation (OR 2.20, 95% CI 1.24–3.91; p = 0.007), height of anastomosis (OR 0.74, 95% CI 0.63–0.88; p < 0.001), and diverting ileostomy (OR 2.59, 95% CI 1.27–5.30; p = 0.009) were independent risk factors for major LARS.


Long-course neoadjuvant radiation, along with low anastomosis, are likely independent risk factors for postoperative bowel function and QOL. Our findings might have implications for alleviating LARS and improving QOL by informing selection of neoadjuvant treatment.



This study was supported by National Natural Scientific Foundation of China grants (Nos. 31601077 to RD, and 81573078 to LW), Natural Science Foundation of Guangdong Province grant (No. 2016A030311021 to LW), and Guangzhou 44 Science and Technology Plan (No. 201604020005 to JW).

Authors’ Contributions

Conception and design: RD, YD, LW, JW. Acquisition of data: WS, RD, JC, LR, SL. Analysis and interpretation of data: WS, RD, LH, JC, CZ, LR. Writing and revision of the manuscript: WS, RD, LH, CZ. Review of the manuscript: LK, PL, LW, JW.


The authors declare that they have no conflict of interest.

Supplementary material

10434_2018_7096_MOESM1_ESM.docx (2.2 mb)
Supplementary material 1 (DOCX 2286 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Colorectal Surgery, The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouChina
  2. 2.Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouChina
  3. 3.Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouChina
  4. 4.Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouChina
  5. 5.Department of Medical Oncology, The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouChina

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