A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors

• Published in: International journal of surgery (London, England) Vol. 56; pp. 234 - 241
• Main Authors: Croese, Alexander D., Lonie, James M., Trollope, Alexandra F., Vangaveti, Venkat N., Ho, Yik-Hong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.08.2018
• Subjects: Aged; Bowel dysfunction; Colectomy - adverse effects; Denmark - epidemiology; Female; Humans; Low anterior resection; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prevalence; Quality of life; Rectal Diseases - epidemiology; Rectal Diseases - etiology; Rectal neoplasms; Rectal Neoplasms - surgery; Risk Factors; Syndrome; United Kingdom - epidemiology; Low anterior resection; Bowel dysfunction; Prevalence; Rectal neoplasms; Quality of life
• ISSN: 1743-9191; 1743-9159; 1743-9159
• DOI: 10.1016/j.ijsu.2018.06.031

To summarize the reported prevalence and causative factors of Low Anterior Resection Syndrome (LARS) from studies using the LARS score. A systematic literature search was conducted using Pubmed, Ovid Medline and the Cochrane database. Searches were performed using a combination of MeSH (medical subject headings) terms and key terms. Studies that were included used the LARS score as their primary collection tool. Studies were excluded if initial surgery was not for malignancy, or if the majority of LARS scores were from patients less than 1 year post initial surgery or closure of diverting stoma. Eligible studies were assessed with a validated quality assessment tool prior to performing a meta-analysis with quality effects model. Meta-analysis was conducted with prevalence estimates that had been transformed using the double arcsine method. Following the initial search and implementation of inclusion and exclusion criteria 11 studies were deemed suitable for meta-analysis. Meta-analysis found the estimated prevalence of major LARS was 41% (95% CI 34 -48). Where possible outlier studies were excluded, the prevalence was 42% (95%CI 35-48). Radiotherapy and tumour height were the most consistently assessed variables, both showing a consistent negative effect on bowel function. Defunctioning ileostomy was found to have a statically significant negative impact on bowel function in 4 of 11 studies. The majority of reported data has been produced by groups in Denmark and the United Kingdom with limited numbers provided by other locations. Available data is heterogenous with some variables having limited numbers, making meta-analysis of certain variables impossible. There is significant prevalence of Low Anterior Resection Syndrome following oncological rectal resection. A low anastomotic height or history of radiotherapy are major risk factors. •Low anterior resection syndrome (LARS) more common due high rates of sphincter preserving surgery.•The LARS score was designed to make a meta-analysis of the syndrome possible.•Risk factors need to be defined in order to attempt preventing LARS.•Need to increase awareness of syndrome to appropriately council patients.