Uncovering the Secret Clues: Using Stool Calprotectin to Improve Low Anterior Resection Syndrome after Surgery

Abstract

Abstract Background: A majority of patients who undergo low rectal resection experience a frequent complication of low anterior resection syndrome (LARS). It is characterized by distressing bowel dysfunction such as urgency, frequency, and incontinence. Despite the high prevalence of LARS, its management remains challenging due to the lack of reliable diagnostic and monitoring tools. Objectives: This study investigates the relationship between stool calprotectin levels and LARS severity and evaluates the effectiveness of mesalamine treatment. Design: This prospective study involved 48 patients with low rectal cancer who had undergone resection with temporary ileostomy. The patients subsequently presented with LARS for over four weeks after ileostomy closure. Patient and Methods: LARS diagnosis was based on the LARS score, and stool calprotectin levels were measured at baseline and one month and six months post-ileostomy closure. Patients with elevated calprotectin levels received mesalamine treatment and dietary modifications. Statistical analyses were performed to determine the correlation between calprotectin levels and LARS scores using Pearson correlation analysis, linear regression analysis, paired t-test, and ANOVA. Main Outcome Measure: The predictive capacity for stool calprotectin for LARS was the main outcome variable. Sample Size: Forty-eight patients who underwent low rectal cancer resection were enrolled. Results: Among the study group, 28 were males and 20 were females. The mean age was 50 (9.998) years, 95% confidence interval CI = [17–78]) in both groups. The predictive value of calprotectin levels for LARS severity was high with β = 0.72, P-value < .001, and R² 0.55. The mean (SD) stool calprotectin level was 360 (6.282) mcg/g, which correlated with severe LARS symptoms (mean [SD] LARS score = 35 [2.449]). After six months, 60% of patients showed significant improvement (LARS scores <20), 30% had minor improvement (LARS scores 29–30), and 10% showed no improvement. Correlation analysis revealed a strong positive correlation between calprotectin levels and LARS scores (r = 0.75, P < .001). Conclusion: Stool calprotectin is demonstrated to be a promising biomarker for diagnosing and monitoring LARS. The findings highlight the association between LARS and high levels of stool calprotectin. However, the study had limitations of being a single-center study, comprising a small sample size, and not using a randomized clinical trial to evaluate the effectiveness of mesalamine. Conflicts of Interest: None.