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Low anterior resection syndrome: can it be prevented?

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Abstract

Surgery remains the cardinal treatment in colorectal cancers but changes in bowel habits after rectal cancer surgery are common and disabling conditions that affect patients’ quality of life. Low anterior resection syndrome is a disorder of bowel function after rectal resection resulting in a lowering of the QoL and recently has been defined by an international working group not only by specified symptoms but also by their consequences. This review aims to explore an extensive bibliographic research on preventive strategies for LARS. All “modifiable variables,” quantified by the LARS Score, such as type of anastomosis, neoadjuvant therapy, surgical strategy, and diverting stoma, were evaluated, while “non-modifiable variables” such as age, sex, BMI, ASA, preoperative TMN, tumor height, and type of mesorectal excision were excluded from the comparative analysis. The role of defunctioning stoma, local excision, neoadjuvant radiotherapy, and non operative management seems to significantly affect risk of LARS, while type of anastomosis and surgical TME approach do not impact on LARS incidence or gravity in the long term period. Although it is established that some variables are associated with a greater onset of LARS, in clinical practice, technical difficulties and oncological limits often make difficult the application of some prevention plans. Transtomal irrigations, intraoperative neuromonitoring, pelvic floor rehabilitation before stoma closure, and early transanal irrigation represent new arguments of study in preventive strategies which could, if not eliminate the symptoms, at least mitigate them.

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Authors and Affiliations

  1. Department of Medicine and Surgery, University of Parma, Parma, Italy

    Alfredo Annicchiarico

  2. Emergency Surgery, Careggi University Hospital, Florence, Italy

    Jacopo Martellucci, Maximilian Scheiterle, Carlo Bergamini & Paolo Prosperi

  3. Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy

    Stefano Solari

Authors
  1. Alfredo Annicchiarico
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  2. Jacopo Martellucci
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  3. Stefano Solari
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  4. Maximilian Scheiterle
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  5. Carlo Bergamini
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  6. Paolo Prosperi
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Contributions

Annicchiarico A. and Martellucci J. designed the research; Annicchiarico A., Martellucci J., Solari S., Scheiterle M., and Bergamini C. performed the research (acquisition of data); Annicchiarico A., Martellucci J., and Solari S. analyzed and interpreted the data; Annicchiarico A. and Martellucci J. wrote the article; Annicchiarico A., Martellucci J., and Prosperi P. revised the article; all authors gave their final approval.

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Correspondence to Alfredo Annicchiarico.

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Core tip

Colorectal resection is one of the most discussed topics in recent literature. Although technical notes and oncological outcomes represent essential arguments of discussion about this disease, functional symptoms resulting from anterior resection syndrome are often neglected and the preventive strategies that can allow a decrease in their onset are usually disregarded. This review aims to address and analyze the actual major prevention techniques and possible future horizons

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Annicchiarico, A., Martellucci, J., Solari, S. et al. Low anterior resection syndrome: can it be prevented?. Int J Colorectal Dis 36, 2535–2552 (2021). https://doi.org/10.1007/s00384-021-04008-3

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