Longitudinal changes in bowel function and quality of life after restorative rectal cancer surgery in a Moroccan cohort

Abstract Background Bowel dysfunction following restorative rectal cancer surgery can persist despite improvement over time. We examined within-patient changes in bowel function and health-related quality of life at recorded 3-, 6- and 12-month assessments in a Moroccan cohort. Methods This single-centre observational analysis included 50 patients with endoscopically recorded rectal adenocarcinoma from a 78-patient colorectal dataset. The remaining 28 rectosigmoid cases were described separately. Low anterior resection syndrome (LARS), Wexner incontinence and European Organisation for Research and Treatment of Cancer QLQ-C30 scores were calculated from individual items. The primary endpoint was the paired change in LARS score between 3 and 12 months. Mean changes were estimated with participant-level bootstrap 95% confidence intervals (CIs). Associations between 12-month LARS and quality of life were exploratory. Results Mean age was 58.3 years; 25 patients were women. Forty-five received chemoradiotherapy and 42 underwent protective ileostomy. LARS scores were available for 42, 43 and 43 patients at 3, 6 and 12 months. Among 40 patients with paired assessments, mean LARS decreased from 34.1 to 23.5, a change of − 10.6 points (95% CI − 12.8 to − 8.3). Major LARS decreased from 31/40 (77.5%) to 10/40 (25.0%). Mean paired Wexner score decreased by 4.9 points (95% CI 3.8–6.0 improvement). Among 49 paired respondents, global health status/quality of life increased by 12.1 points (95% CI 9.5–14.6). At 12 months, higher LARS scores correlated with lower global quality of life (Spearman rho − 0.66; 95% CI − 0.81 to − 0.45; n = 43). Conclusions Bowel function and global quality of life improved between the recorded 3- and 12-month assessments, but major LARS persisted in one quarter of paired respondents. These findings support repeated functional assessment while requiring cautious interpretation because of missing questionnaires, heterogeneous treatment and the absence of preoperative measurements.