Low Anterior Resection Syndrome
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LARGE INTESTINE (R CHOKSHI, SECTION EDITOR)
Low Anterior Resection Syndrome Theresa H. Nguyen 1,2 & Reena V. Chokshi 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Low anterior resection syndrome is a highly prevalent condition that can develop after anal sphincter-sparing surgery for rectal cancer and impair quality of life. In this review, we summarize the major features and pathophysiology of this syndrome and discuss treatment approaches. Recent Findings Quality of life correlates significantly with severity of low anterior resection syndrome. Prompt assessment and initiation of therapy are essential to rehabilitating damaged mechanical and neural structures. Anorectal manometry demonstrates a global decrease in sphincteric function postoperatively, though in many patients, function does recover. Transanal irrigation, pelvic floor rehabilitation, and biofeedback are the mainstays of the treatment of major LARS. Definitive stoma can be considered in therapy refractory LARS > 2 years. Summary The development of low anterior resection syndrome likely involves an interplay between mechanical and neural pathways. Clinically, patients present at varying levels of severity, and scoring systems are available to help assess patient symptoms and guide therapy. Treatment approaches range from conservative therapies to biofeedback and sacral nerve stimulation. Future randomized controlled trials aimed at risk stratification of patients and development of severity-based treatment algorithms are warranted. Keywords Low anterior resection syndrome . Internal anal sphincter . Fecal incontinence . Urgency . Rectal cancer
Introduction Colorectal cancer is the third most commonly diagnosed cancer worldwide, and rectal cancer accounts for over one-third of cases, with an age-standardized incidence rate of 7.7 per 100,000 [1]. Low anterior resection of the rectum with total mesorectal excision for the treatment of rectal cancer allows patients to avoid the permanent colostomy that is associated with an abdominoperineal resection [2]. However, a potential consequence of this surgery is low anterior resection syndrome (LARS). The prevalence of LARS is high, with approximately 80–90% of individuals who undergo sphincterThis article is part of the Topical Collection on Large Intestine
preserving surgery experiencing varying degrees of severity [3]. LARS is difficult to fully define but consists of any altered defecation status occurring after an anal sphincterpreservation operation for rectal cancer. Symptoms include fecal incontinence, urgency, and incomplete evacuation. Short-term symptoms (resolution within 6–12 months after anal sphincter-sparing surgery) are usually due to short-lived neorectal irritability in the postoperative period. Long-term symptoms of LARS (extending more than 12 months after surgery) are more likely due to permanent changes [4]. Around 46–49% of patients who undergo anal sphinctersparing surgery still experience symptoms of LARS at a follow-up period o
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