Low anterior resection syndrome: can it be prevented?

Area of Science:

• Colorectal Surgery
• Oncology
• Gastroenterology

Background:

• Rectal cancer surgery frequently leads to low anterior resection syndrome (LARS), a condition significantly impacting patient quality of life.
• LARS is characterized by specific bowel dysfunction symptoms and their consequences following rectal resection.

Purpose of the Study:

• To conduct an extensive literature review on preventive strategies for LARS.
• To evaluate modifiable variables influencing LARS incidence and severity.

Main Methods:

• Bibliographic research focusing on modifiable variables (anastomosis type, neoadjuvant therapy, surgical strategy, diverting stoma).
• Exclusion of non-modifiable variables (age, sex, BMI, tumor characteristics, etc.) from comparative analysis.

Main Results:

• Defunctioning stoma, local excision, neoadjuvant radiotherapy, and non-operative management significantly impact LARS risk.
• Anastomosis type and total mesorectal excision (TME) approach did not show long-term impact on LARS incidence or severity.
• Clinical application of prevention plans is often limited by technical and oncological challenges.

Conclusions:

• Certain strategies can mitigate LARS risk, but practical implementation faces challenges.
• Emerging strategies like transtomal irrigations, intraoperative neuromonitoring, pelvic floor rehabilitation, and early transanal irrigation warrant further investigation for symptom management.