Low anterior resection syndrome: Risk factors, pathophysiology, assessment, and treatment – a narrative review

Aim: Low anterior resection syndrome (LARS) is a dysfunction of bowel evacuation following sphincter-preserving surgery (robotic, laparoscopic, or open) for rectal cancer. Patients commonly experience changes in bowel habits ranging from increased bowel frequency to faecal incontinence and evacuatory dysfunction. The aim of this study was to provide evidence-based recommendations for good clinical practice. Materials and methods: A literature search was conducted in PubMed and ResearchGate using the following keywords: low anterior resection syndrome, low anterior resection syndrome treatment, and low anterior resection syndrome scoring systems. Manual searches of references of the included studies were performed to identify other relevant publications. Only studies published in English were included. Results: In 2012 Emmertsen and Laurberg developed a questionnaire with a scoring system (the LARS score) that evaluates symptom severity and classifies patients into three groups: no LARS, minor LARS, and major LARS. A symptom-based therapeutic approach has been developed for the management of LARS. There is limited evidence that dietary modification improves symptoms. Medications such as loperamide and ramosetron have been shown to improve patients‘ quality of life. Pelvic floor rehabilitation is used to improve the function of the anal sphincter complex. Transanal irrigation has demonstrated significant improvement in symptoms. Sacral nerve modulation and posterior tibial nerve stimulation have shown promising results in patients with LARS who are resistant to conservative treatment. The creation of a colonic J-pouch has also been associated with a better quality of life compared with a straight coloanal or colorectal anastomosis. Conclusion: Many treatment modalities help relieve the symptoms of LARS; currently, however, no definitive cure exists. Further clinical research and studies are needed to develop effective treatment strategies and ultimately achieve a cure for LARS.