Treatment possibilities for low anterior resection syndrome: a review of the literature
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Up to 80% of patients after low anterior resection, experience (low) anterior resection syndrome (ARS/LARS). However, there is no standard treatment option currently available. This systemic review aims to summarize treatment possibilities for LARS after surgical treatment of rectal cancer in the medical literature.
Embase, PubMed, and the Cochrane Library were searched using the terms anterior resection syndrome, low anterior resection, colorectal/rectal/rectum, surgery/operation, pelvic floor rehabilitation, biofeedback, transanal irrigation, sacral nerve stimulation, and tibial nerve stimulation. All English language articles presenting original patient data regarding treatment and outcome of LARS were included. We focused on the effects of different treatment modalities for LARS. The Jadad score was used to assess the methodological quality of trials. The quality scale ranges from 0 to 5 points, with a score ≤ 2 indicating a low quality report, and a score of ≥ 3 indicating a high quality report.
Twenty-one of 160 studies met the inclusion criteria, of which 8 were reporting sacral nerve stimulation, 6 were designed to determine pelvic floor rehabilitation, 3 studies evaluated the effect of transanal irrigation, 2—percutaneous tibial nerve stimulation, and the rest of the studies assessed probiotics and 5-HT3 receptor antagonists for LARS in patients who had undergone rectal resection. All except one study were poor quality reports according to the Jadad score.
LARS treatment still carries difficulties because of a lack of well-conducted, randomized multicenter trials. Well-performed randomized controlled trials are needed.
KeywordsRectal cancer surgery Low anterior resection Low anterior resection syndrome Treatment
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Keane C, Wells C, O'Grady G, Bissett IP (2017) Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis doi: https://doi.org/10.1111/codi.13767. [Epub ahead of print], 19, 8, 713, 722
- 6.Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255(5):922–928. https://doi.org/10.1097/SLA.0b013e31824f1c21 CrossRefPubMedGoogle Scholar
- 16.Bols E, Berghmans B, de Bie R, Govaert B, van Wunnik B, Heymans M, Hendriks E, Baeten C (2012) Rectal balloon training as add-on therapy to pelvic floor muscle training in adults with fecal incontinence: a randomized controlled trial. Neurourol Urodyn 31(1):132–138. https://doi.org/10.1002/nau.21218 CrossRefPubMedGoogle Scholar
- 17.Visser WS, te Riele WW, Boerma D, van Ramshorst B, van Westreenen HL (2014) Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Ann Coloproctol 30(3):109–114. https://doi.org/10.3393/ac.2014.30.3.109 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Allgayer H, Dietrich CF, Rohde W, Koch GF, Tuschhoff T (2005) Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol 40(10):1168–1175. https://doi.org/10.1080/00365520510023477 CrossRefPubMedGoogle Scholar
- 19.Kim KH, CS Y, Yoon YS, Yoon SN, Lim SB, Kim JC (2011) Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery. Dis Colon rectum 54(9):1107–1113. https://doi.org/10.1097/DCR.0b013e318221a934
- 21.Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y (2012) Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Color Dis 14(10):1231–1237. https://doi.org/10.1111/j.1463-1318.2012.02956.x CrossRefGoogle Scholar
- 28.Ratto C, Grillo E, Parello A, Petrolino M, Costamagna G, Doglietto GB (2005) Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon rectum 48(5):1027–1036. https://doi.org/10.1007/s10350-004-0884-5 CrossRefPubMedGoogle Scholar
- 34.D'Hondt M, Nuytens F, Kinget L, Decaestecker M, Borgers B, Parmentier I (2017) Sacral neurostimulation for low anterior resection syndrome after radical resection for rectal cancer: evaluation of treatment with the LARS score. Tech Coloproctol 21(4):301–307. https://doi.org/10.1007/s10151-017-1612-1 CrossRefPubMedGoogle Scholar
- 36.Itagaki R, Koda K, Yamazaki M, Shuto K, Hirano A, Arimitsu H, Shiragami R, Yoshimura Y, Suzuki M (2014) Serotonin (5-HT3) receptor antagonists for the reduction of symptoms of low anterior resection syndrome. Clin Exp Gastroenterol 7:47–52. https://doi.org/10.2147/CEG.S55410 PubMedPubMedCentralGoogle Scholar
- 39.Del Popolo G, Mosiello G, Pilati C, Lamartina M, Battaglino F, Buffa P, Redaelli T, Lamberti G, Menarini M, Benedetto P di, Gennaro M de (2008) Treatment of neurogenic bowel dysfunction in patients with spinal cord injury. Spinal Cord 46(7):517–522. https://doi.org/10.1038/sj.sc.3102167
- 41.Christensen P, Krogh K, Buntzen S, Payandeh F, Laurberg S (2009) Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence. Dis Colon rectum 52(2):286–292. https://doi.org/10.1007/DCR.0b013e3181979341
- 46.Altomare DF, Picciariello A, Ferrara C, Digennaro R, Ribas Y, de Fazio M (2017) Short-term outcome of percutaneous tibial nerve stimulation for low anterior resection syndrome: results of a pilot study. Colorectal Dis doi 19(9):851–856. https://doi.org/10.1111/codi.13669. [Epub ahead of print]CrossRefGoogle Scholar
- 47.Vigorita V, Rausei S, Troncoso Pereira P, Trostchansky I, Ruano Poblador A, Moncada Iribarren E, Facal Alvarez C, de San Ildefonso Pereira A, Casal Núñez E (2017) A pilot study assessing the efficacy of posterior tibial nerve stimulation in the treatment of low anterior resection syndrome. Tech Coloproctol 21(4):287–293. https://doi.org/10.1007/s10151-017-1608-x CrossRefPubMedGoogle Scholar