Abstract
Low anterior resection syndrome (LARS) is a constellation of symptoms consisting of
stool or flatus incontinence, urgency, and/or clustering of bowel movements. Up to
80% of patients experience these symptoms after sphincter-sparing surgery for rectal
cancer with concomitant decrease in quality of life. Multiple measurement tools have
been developed and different treatment options have been explored. The purpose of
this review was to evaluate LARS assessment tools, treatment options, and the supporting
evidence for these strategies. We performed a literature review related to the evaluation
and treatment of LARS, and ongoing clinical trials up to 2024 were reviewed. We found
the definition of LARS was recently revised, with current validated diagnostic tools
lagging behind this update. First-line treatment includes optimizing bowel habits,
dietary changes, and medications. Second-line treatment includes pelvic floor rehabilitation
or transanal irrigation. Third-line treatment includes sacral nerve stimulation or
posterior tibial nerve stimulation before the discussion of antegrade enemas or permanent
stoma creation. In summary, LARS remains a challenging symptomatic disorder to capture
and treat effectively. There are opportunities for better standardization of preoperative
education, evaluation, and escalation of treatment strategies. Further investigation
into psychosocial and patient support adjuncts need to be developed. Continued research
will help to refine and develop a clear treatment algorithm.
Keywords
rectal cancer - low anterior resection - low anterior resection syndrome
