Colorectal surgeon practice patterns of low anterior resection syndrome after rectal cancer treatment

Limited literature exists regarding surgeon perceptions and practice patterns for low anterior resection syndrome (LARS). In this study, we sought to understand how colon and rectal surgery faculty perceive and manage LARS.

We invited colon and rectal surgery faculty (CRS faculty) members from all programs that offer an Accreditation Council for Graduate Medical Education (ACGME)-accredited colon and rectal surgery residency (n = 378) to participate in an electronic survey. Descriptive statistical analyses and ordered logistic regression were performed.

The survey achieved a response rate of 30.1% (116/378). The most common number of years in practice was 11-20 (33.6%). Many surgeons always counsel their patients on the risk of LARS preoperatively (76.7%), but 42.4% never routinely screen for LARS following rectal resection. One tenth of surgeons (10.3%) do not treat LARS. The treatment most often "always" used for LARS was lifestyle modifications with drug treatment (32.7%), followed by physical therapy (18.5%). Years in practice was significantly related to frequency of using biofeedback (OR = 0.74, 95% CI 0.54-1.00; p = 0.050), transanal irrigation (OR = 1.39, 95% CI 1.00-1.92; p = 0.047) and PFPT (OR = 0.73, 95% CI 0.54-0.98; p = 0.039).

Most CRS faculty counsel patients preoperatively about the risk of LARS and employ some treatment modality. The low rate of postoperative screening for LARS could be improved and there is a wide variation in LARS treatment practice. Updated guidelines for the management of LARS that incorporate recent literature, increased screening of postoperative patients, and efforts to provide patients access to effective treatments could help clinicians and patients to manage a difficult condition.