Low anterior resection syndrome: a survey of the members of the American Society of Colon and Rectal Surgeons (ASCRS), the Spanish Association of Surgeons (AEC), and the Spanish Society of Coloproctology (AECP)
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Low anterior resection syndrome (LARS) is frequent following sphincter-sparing procedures for rectal cancer.
This study aims to assess surgeons’ awareness of LARS.
This was a survey study.
Members of the American Society of Colon and Rectal Surgeons (ASCRS), the Spanish Association of Surgeons (AEC), and the Spanish Society of Coloproctology (AECP).
Three hundred thirty-four surgeons from the ASCRS and 150 from the Spanish Societies completed a 23-item electronic questionnaire.
Main outcome measures
Surgeons’ opinions regarding different aspects of LARS.
The proportion of rectal cancer patients undergoing sphincter-sparing operations ranged between 71 and 90 %. Low anterior resection with end-to-end anastomosis was the most frequently cited procedure after mesorectal excision. More than 80 % of participants were recognized to be moderately or extremely aware of the condition, but regarding the method used to assess LARS, the majority relied on clinical manifestations. Around 35 % of surgeons considered that severe LARS developed in less than 40 % of patients. The most important factor related to defecatory function impairment in the surgeons’ opinion was the distance from the anal margin to anastomosis. Other factors thought to be involved were anastomotic leakage, preoperative radiation therapy, age, and postoperative radiotherapy, with similar percentages in the two groups of surgeons. Lifestyle changes and dietary measures associated with or without drug treatment was the modality of choice. The experience with transanal irrigation or sacral nerve stimulation was limited. It was considered that <30 % of patients chronically suffer from severe LARS with significant quality of life impairment.
The limitations of this study are the international mix and expert status of the specialists.
The probability of patients suffering from LARS was underestimated despite reporting good knowledge of the syndrome. Validated methods for the assessment of LARS were rarely used. Deficient awareness regarding risk factors for LARS was documented. Knowledge of therapeutic options was also limited.
KeywordsLow anterior resection syndrome Rectal cancer Low anterior resection Surgeon’s opinion Survey study
The authors thank Marta Pulido, MD, for editing the manuscript and editorial assistance.
Contribution of each author
L.M. Jimenez-Gomez: conception and design of the study, development of the survey questionnaire, implementation of the web-based platforms, analysis and interpretation of results, writing of the manuscript, and approval the final draft.
E. Espin-Basany: conception and design of the study, collection of data, analysis and interpretation of results, revision of the initial draft for intellectual content, and approval the final draft.
M. Marti-Gallostra: analysis of results, revision of the manuscript, and approval of the final draft.
J.L. Sanchez-Garcia: analysis of results, revision of the manuscript, and approval of the final draft.
F. Vallribera-Valls: analysis of results, revision of the manuscript, and approval of the final draft.
M. Armengol-Carrasco: supervision and coordination of the study, analysis and interpretation of results, and approval of the final draft.
Compliance with ethical standards
Conflicts of interest
None of the authors has any conflict of interest to be declared.
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