Low anterior resection syndrome-Causes and treatment approaches

Background With improvement of the oncological prognosis and more sphincter-preserving procedures for rectal cancer of the lower third, the functional sequelae of anterior rectal resection become more and more predominant and are summarized under the term low anterior resection syndrome (LARS). Material and methods In this narrative review the causes, associated factors, prevalence, diagnostics and treatment strategies are presented based on an evaluation of the international literature. Results The central role of the rectum in the physiology of defecation and continence explains the frequency of symptoms following anterior rectal resection. In an unselected patient population a major LARS is to be expected in approximately 40% and a minor LARS in approximately 20%. The most important factor is the length of the remaining rectal stump. The diagnosis of LARS is made clinically and can be quantified by scores, especially by the LARS score. Treatment options range from patient counselling to stoma construction and a symptom-related, stepwise approach is generally accepted. Conclusion While the evidence for the causes, the quantification and determination of associated factors of LARS is good, the treatment options are based either on experience or on only few studies.

Automated summary

The functional sequelae of anterior rectal resection, known as low anterior resection syndrome (LARS), are becoming more predominant with improved oncological prognosis in rectal cancer patients. Approximately 40% of patients are expected to experience major LARS, while about 20% may have minor LARS, with the length of the remaining rectal stump being a key factor. Diagnosis and quantification of LARS are clinically based, and treatment options vary from patient counseling to surgical interventions.