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Background <p>Sphincter-sparing low anterior resection (SSLAR) with neoadjuvant radio-chemotherapy has been developed to avoid abdomino-perineal amputation and permanent colostomy in patients with low rectal cancer. However, many patients develop symptoms known as low anterior resection syndrome (LARS), including fecal urgency, incontinence, and a sensation of incomplete evacuation. The Low Anterior Resection Syndrome Score (LARS Score), a validated tool developed by Emmertsen and Laurberg, is used to assess symptom severity and guide treatment.</p> Materials and methods <p>We present a single-center cohort study including patients having undergone SSLAR for rectal cancer between 2014 and 2021 at Fribourg Cantonal Hospital. Initial LARS-scores were obtained by completion of the QoL questionnaire. Patients with minor LARS (scores 21–29) were treated with electrostimulation and bio-feedback physiotherapy. Those with major LARS (scores &gt; 29) were first investigated by anal manometry followed by physiotherapy. All treatments took place in 2022/2023. After treatment, LARS-scores were calculated again.</p> Results <p>Of 54 patients included in the study, 18.5% had minor LARS, 40.8% major LARS, and 40.8% had no LARS. Of all patients with LARS, 18 (56%) completed pelvic physiotherapy, whereas 14 (44%) refused the treatment. Before and after pelvic physiotherapy, the median LARS score was 32 [interquartile range 29.50–38.50] and 22.5 [18.5–28], respectively (<i>p</i> &lt; 0.001 according to Wilcoxon signed-rank test). Analysis of risk factors did not reveal any significant difference in age, gender, diabetes, nicotine or alcohol use, previous abdominal surgery, tumor stage, chemo/radiotherapy, type of operation and anastomosis, or anastomotic leakage.</p> Conclusions <p>Approximately half of patients undergoing SSLAR experience LARS, and approximately one-third develop the major form. LARS scores may significantly improve with specific physiotherapeutic measures that have therefore been introduced as a standard procedure for all SSLAR patients at our institution.</p>

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Score assessment and treatment in patients presenting with low anterior resection syndrome after sphincter-sparing rectal cancer surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月14日

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  • R. Sguinzi,
  • J. Fiechter,
  • L. Bafumi,
  • B. Gremaud,
  • B. Geng,
  • P. Janiak,
  • L. Bühler,
  • B. Egger

摘要

Background

Sphincter-sparing low anterior resection (SSLAR) with neoadjuvant radio-chemotherapy has been developed to avoid abdomino-perineal amputation and permanent colostomy in patients with low rectal cancer. However, many patients develop symptoms known as low anterior resection syndrome (LARS), including fecal urgency, incontinence, and a sensation of incomplete evacuation. The Low Anterior Resection Syndrome Score (LARS Score), a validated tool developed by Emmertsen and Laurberg, is used to assess symptom severity and guide treatment.

Materials and methods

We present a single-center cohort study including patients having undergone SSLAR for rectal cancer between 2014 and 2021 at Fribourg Cantonal Hospital. Initial LARS-scores were obtained by completion of the QoL questionnaire. Patients with minor LARS (scores 21–29) were treated with electrostimulation and bio-feedback physiotherapy. Those with major LARS (scores > 29) were first investigated by anal manometry followed by physiotherapy. All treatments took place in 2022/2023. After treatment, LARS-scores were calculated again.

Results

Of 54 patients included in the study, 18.5% had minor LARS, 40.8% major LARS, and 40.8% had no LARS. Of all patients with LARS, 18 (56%) completed pelvic physiotherapy, whereas 14 (44%) refused the treatment. Before and after pelvic physiotherapy, the median LARS score was 32 [interquartile range 29.50–38.50] and 22.5 [18.5–28], respectively (p < 0.001 according to Wilcoxon signed-rank test). Analysis of risk factors did not reveal any significant difference in age, gender, diabetes, nicotine or alcohol use, previous abdominal surgery, tumor stage, chemo/radiotherapy, type of operation and anastomosis, or anastomotic leakage.

Conclusions

Approximately half of patients undergoing SSLAR experience LARS, and approximately one-third develop the major form. LARS scores may significantly improve with specific physiotherapeutic measures that have therefore been introduced as a standard procedure for all SSLAR patients at our institution.