Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 13;28(1):10.
doi: 10.1007/s10151-023-02872-5.

Preventative strategies for low anterior resection syndrome

H Brock #  1   2   3 , L Lambrineas #  1 , H I Ong #  4   5 , W Y Chen  1 , A Das  2 , A Edsell  1 , D Proud  1   2 , E Carrington  6 , P Smart  1   2 , H Mohan  1   2 , A Burgess  1   2
Affiliations

Preventative strategies for low anterior resection syndrome

H Brock et al. Tech Coloproctol. .

Abstract

Background: A common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly understood and challenging to treat. Despite this, prevention strategies are commonly overlooked. Our aim was to review the pathophysiology of LARS and explore current evidence on the efficacy and feasibility of prophylactic techniques.

Methods: A literature review was performed between [1st January 2000 to 1st October 2023] for studies which investigated preventative interventions for LARS. Mechanisms by which LARS develop are described, followed by a review of prophylactic strategies to prevent LARS. Medline, Cochrane, and PubMed databases were searched, 189 articles screened, 8 duplicates removed and 18 studies reviewed.

Results: Colonic dysmotility, anal sphincter dysfunction and neorectal dysfunction all contribute to the development of LARS, with the complex mechanism of defecation interrupted by surgery. Transanal irrigation (TAI) and pelvic floor rehabilitation (PFR) have shown benefits in preventing LARS, but may be limited by patient compliance. Intraoperative nerve monitoring (IONM) and robotic-assisted surgery have shown some promise in surgically preventing LARS. Nerve stimulation and other novel strategies currently used in treatment of LARS have yet to be investigated in their roles prophylactically.

Conclusions: To date, there is a limited evidence base for all preventative strategies including IONM, RAS, PFP and TAI. These strategies are limited by either access (IONM, RAS and PFP) or acceptability (PFP and TAI), which are both key to the success of any intervention. The results of ongoing trials will serve to assess acceptability, while technological advancement may improve access to some of the aforementioned strategies.

Keywords: Low anterior resection syndrome; Prevention; Rectal cancer.

PubMed Disclaimer

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249 - PubMed
    1. Fields AC, Scully RE, Saadat LV, Lu P, Davids JS, Bleday R et al (2019) Oncologic outcomes for low rectal adenocarcinoma following low anterior resection with coloanal anastomosis versus abdominoperineal resection: a National Cancer Database propensity matched analysis. Int J Colorectal Dis 34(5):843–848 - PubMed
    1. Ye L, Huang M, Huang Y, Yu K, Wang X (2022) Risk factors of postoperative low anterior resection syndrome for colorectal cancer: a meta-analysis. Asian J Surg 45(1):39–50 - PubMed
    1. Juul T, Elfeki H, Christensen P, Laurberg S, Emmertsen KJ, Bager P (2019) Normative data for the Low Anterior Resection Syndrome Score (LARS Score). Ann Surg 269(6):1124–1128 - PubMed
    1. Falz R, Bischoff C, Thieme R, Lassing J, Mehdorn M, Stelzner S et al (2022) Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 148(9):2187–2213 - PubMed - PMC

Publication types

MeSH terms

LinkOut - more resources