Low Anterior Resection Syndrome

Regardless of the method used for rectal reconstruction, and potentially independent of the use of pelvic radiation, 60% to 90% of patients undergoing proctectomy will develop “low anterior resection syndrome” (LARS).[1],[2],[3],[4] This syndrome of defecatory dysfunction is defined by a constellation of symptoms including frequency, urgency, fragmentation (incomplete evacuation and bowel movement “stacking”) and fecal incontinence. For some patients, LARS results in “toilet dependence” and a fear of leaving the home. Thus LARS may have a major effect on quality of life. Multiple causative factors are involved, including a loss of the reservoir function of the resected rectum with impaired capacity and compliance of the neo-rectum[5], iatrogenic internal sphincter damage[6], autonomic nerve injury[7], effects of chemoradiation[8], changes in the colonic motility following mobilization of the left colon[9], and pelvic floor disease predating surgery.[10],[11]

It is imperative that the surgeon counsel the patient preoperatively regarding the functional expectations after rectal resection and reconstruction. Such proper and comprehensive education and counseling can better empower a patient as they decide on the prudence of rectal reconstruction and the consequences of that decision. While LARS is predominately a physical problem, it can have a major impact on body image and psychosocial aspects of life for patients, specifically surrounding confidence and normality.[1] In reality, it is the rare patient who opts for permanent stoma simply because of the potential of postoperative bowel dysfunction.