Clinical Manifestation and Treatment of Low Anterior Resection Syndrome

Abstract

Globally, colorectal cancer is one of the most prevalent cancers and following sphincter-preserving procedures for rectal cancer, many patients experience various forms of bowel dysfunction. Low anterior resection syndrome (LARS), which has a detrimental effect on the patients' quality of life, is the most common form in which bowel dysfunction presents and is a frequently reported complication of rectal cancer surgeries. Assessment of LARS severity requires a thorough history taking, physical examination of the patients, use of validated questionnaires, and other diagnostic techniques. The clinical manifestations of LARS can be categorized into two groups. The first includes increased frequency, incontinence, and fecal urgency. The second category includes issues with bowel emptying, incomplete eviction sensations, and constipation. Some patients describe traits from both categories, either switching back and forth between the two patterns or experiencing both at once. Each patient's LARS treatment should be tailored as per need. Patients with major LARS typically require multimodal therapy to achieve acceptable results. Treatment options include minimally invasive techniques as well as conservative care such as pharmacological management, pelvic floor rehabilitation, and transanal irrigation. Fecal diversion might be required if this treatment is unsuccessful. Appropriate Kegel exercise of the anal sphincter and initial precise dissection with preservation of nerves and development of a neorectal reservoir after anastomosis can limit the occurrence of LARS. For patients who have LARS risk factors, pretreatment counselling is a crucial step. The purpose of this research is to review the available information about clinical manifestation and treatment of LARS.