Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer

Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the...

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Published inChinese medical journal Vol. 133; no. 15; pp. 1824 - 1833
Main Authors Sakr, Ahmad, Sauri, Fozan, Alessa, Mohammed, Zakarnah, Eman, Alawfi, Homoud, Torky, Radwan, Kim, Ho Seung, Yang, Seung Yoon, Kim, Nam Kyu
Format Journal Article
LanguageEnglish
Published China Lippincott Williams & Wilkins Ovid Technologies 05.08.2020
Wolters Kluwer Health
Wolters Kluwer
Subjects
Anal Canal - surgery
Cancer therapies
Chemotherapy
Colorectal cancer
Fecal incontinence
Feces
Humans
Motility
Ostomy
Pathophysiology
Patient satisfaction
Postoperative Complications
Quality of Life
Radiation therapy
Rectal Neoplasms - surgery
Review
Risk factors
Surgery
Syndrome
Tumors
Ultrasonic imaging
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Summary:Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.
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ISSN:0366-6999
2542-5641
DOI:10.1097/CM9.0000000000000852