Transanal irrigation: another hope for patients with LARS
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EDITORIAL
Transanal irrigation: another hope for patients with LARS P. Christensen1 · N. S. Fearnhead2 · J. Martellucci3
© Springer Nature Switzerland AG 2020
The number of long-term cancer survivors has tripled over the last 3 decades. It is estimated that there will be 4 million cancer survivors in the UK in 2030. One out of four cancer patients report chronic physical problems that significantly impair their quality of life. Gastrointestinal symptoms are most common side-effect of cancer treatment and have the greatest impact on quality of life. The potential for poor functional outcomes comes into sharp focus with treatment for rectal cancer. The introduction of total mesorectal excision revolutionized treatment and substantially improved local control and survival. Preoperative chemoradiation (CRT) and preoperative shortcourse radiotherapy further significantly reduce recurrence. However, oncological resection of the rectum and restoring bowel continuity, with or without neoadjuvant therapy, is not without consequences for the patient. Numerous studies have reported that 50–80% of patients develop low anterior resection syndrome (LARS) characterized by increased frequency of defecation, urge, faecal incontinence, difficulty in discriminating between flatus or stool, and incomplete rectal evacuation. Living and coping with LARS has a profoundly negative impact on overall quality of life. Recently, a large international consensus trilingual Delphi process with patients as the major stakeholder defined LARS as having at least one of eight symptoms resulting in at least one of eight consequences (see Table 1) after anterior resection [1]. Increasing research has investigated the complex pathophysiology and we now know that the aetiology of LARS is multifactorial with a combination of * P. Christensen [email protected] 1
Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
2
Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
3
General, Emergency and Mini‑Invasive Surgery, Careggi University Hospital, Florence, Italy
loss of reservoir function in the neorectum, biomechanical abnormalities in the neorectum and distal colon, afferent sensory abnormalities from the remnant anal mucosa, and radiotherapy-induced small bowel enteropathy and impaired anal sphincter function after multimodal therapy. With the introduction and widespread use of the LARS score [2] as an easy-to-use short form questionnaire to screen for LARS, now validated in many languages, we are able to identify rectal cancer survivors with life-impacting LARS who need treatment. Unfortunately, despite growing awareness in recent years and focus on the quality of cancer survivorship, management of debilitating LARS is often empirical and symptom based, using existing therapies for fecal incontinence, fecal urgency and rectal evacuatory disorders. As the search co
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