Last update 01 Nov 2024

Low anterior resection syndrome

Last update 01 Nov 2024

Basic Info

Synonyms

LARS - low anterior resection syndrome, Low Anterior Resection Syndrome, Low anterior resection syndrome

+ [3]

Introduction

Postoperative complication after removal of the RECTUM (low anterior resection surgery or resection surgery to the lower part of the COLON). It includes disordered rectum function, e.g., frequent BOWEL MOVEMENT; FECAL INCONTINENCE; and CONSTIPATION.

Drugs associated with Low anterior resection syndrome

Onabotulinumtoxin A

Target

SNAP25

Mechanism

SNAP25 inhibitors

Active Org.

Allergan Ltd. (Ireland) [+7]

Originator Org.

Allergan, Inc.

Active Indication

Masticatory Muscles, Hypertrophy Of [+28]

Inactive Indication

Cerebral Palsy [+32]

Drug Highest PhaseApproved

First Approval Ctry. / Loc.

First Approval Date09 Dec 1991

Lactobacillus Fermentum (HEM Pharma)

Target-

Mechanism

Bacteria replacements [+1]

Active Org.

HEM Pharma, Inc.

Originator Org.

HEM Pharma, Inc.

Active Indication

Low anterior resection syndrome [+1]

Inactive Indication-

Drug Highest PhasePhase 2

First Approval Ctry. / Loc.-

First Approval Date20 Jan 1800

Clinical Trials associated with Low anterior resection syndrome

NCT06475430 / Not yet recruitingNot ApplicableIIT

Evaluation of the Effectiveness of Fecal Microbiota Transplantation in the Treatment of Patients With Severe Low Anterior Resection Syndrome (LARS)

Randomized trial to assess FMT efficacy in improving bowel function for major LARS patients. 40 subjects, blinded, randomized to FMT or probiotics. Pre-post 16S sequencing, 4-week follow-up for bowel symptoms, 8-week microbiota analysis.

Start Date01 Jan 2025

Sponsor / Collaborator

Peking University People's Hospital

NCT06628674 / Not yet recruitingNot ApplicableIIT

Developing and Testing the Effect of Online Interactive Videos in Improving Low Anterior Resection Syndrome, Psychological Distress,and Quality of Life

This study aims to develop and test the effect of online interactive videos in improving LARS.

Start Date01 Nov 2024

Sponsor / Collaborator

Chang Gung Memorial Hospital

ChiCTR2400090954 / SuspendedNot ApplicableIIT

Study on the combination of biofeedback and pelvic floor magnetic stimulation for the treatment of low anterior rectal resection syndrome

Start Date01 Nov 2024

Sponsor / Collaborator-

100 Clinical Results associated with Low anterior resection syndrome

100 Translational Medicine associated with Low anterior resection syndrome

0 Patents (Medical) associated with Low anterior resection syndrome

505

Literatures (Medical) associated with Low anterior resection syndrome

01 Dec 2024·Techniques in Coloproctology

Major low anterior resection syndrome has equivalent health-related quality of life implications as having a permanent colostomy

Article

Author: Koneru, S ; Chapuis, P H ; Rickard, M J F X ; Builth-Snoad, L ; Ng, K-S ; Keshava, A

BACKGROUNDThe literature is inconclusive when comparing health-related quality of life following restorative anterior resection (AR) compared with abdominoperineal resection (APR). Consideration of functional outcomes may explain this inconsistency. The aim of this study was to compare health-related quality of life in patients post-anterior resection, stratified by low anterior resection syndrome score, and post-abdominoperineal resection patients.METHODSA cross-sectional study of consecutive patients post APR and AR for rectal or sigmoid adenocarcinoma at a tertiary centre in Sydney, Australia (Jan 2012- Dec 2021) was performed. HRQoL outcomes (SF36v2 physical [PCS] and mental component summary [MCS] scores) were compared between APR and AR patients, with subgroup analyses stratifying AR patients according to LARS score (no/minor/major). Age- and gender-adjusted comparisons were performed by linear regression.RESULTSOverall, 248 post-AR patients (57.3% male, mean age 70.8 years, SD 11.6) and 64 post-APR patients (62.5% male, mean age 68.1 years, SD 13.1) participated. When stratified by LARS, 'major LARS' had a similar negative effect on age-and sex-adjusted PCS scores as APR. 'No LARS' (p < 0.001) and 'minor LARS' (p < 0.001) patients had higher PCS scores compared to post-APR patients. 'Major LARS' had a similarly negative effect on MCS scores compared with post-APR patients. MCS scores were higher in 'no LARS' (p = 0.006) compared with APR patients.CONCLUSIONSPostoperative bowel dysfunction significantly impacts health-related quality of life. Patients with 'major LARS' have health-related quality of life as poor as those following APR. This requires consideration when counselling patients on postoperative health-related quality of life, especially where poor postoperative bowel function is anticipated following restorative surgery.

01 Dec 2024·Techniques in Coloproctology

Preventative strategies for low anterior resection syndrome

Review

Author: Carrington, E ; Chen, W Y ; Smart, P ; Das, A ; Burgess, A ; Brock, H ; Proud, D ; Ong, H I ; Edsell, A ; Mohan, H ; Lambrineas, L

BACKGROUNDA common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly understood and challenging to treat. Despite this, prevention strategies are commonly overlooked. Our aim was to review the pathophysiology of LARS and explore current evidence on the efficacy and feasibility of prophylactic techniques.METHODSA literature review was performed between [1st January 2000 to 1st October 2023] for studies which investigated preventative interventions for LARS. Mechanisms by which LARS develop are described, followed by a review of prophylactic strategies to prevent LARS. Medline, Cochrane, and PubMed databases were searched, 189 articles screened, 8 duplicates removed and 18 studies reviewed.RESULTSColonic dysmotility, anal sphincter dysfunction and neorectal dysfunction all contribute to the development of LARS, with the complex mechanism of defecation interrupted by surgery. Transanal irrigation (TAI) and pelvic floor rehabilitation (PFR) have shown benefits in preventing LARS, but may be limited by patient compliance. Intraoperative nerve monitoring (IONM) and robotic-assisted surgery have shown some promise in surgically preventing LARS. Nerve stimulation and other novel strategies currently used in treatment of LARS have yet to be investigated in their roles prophylactically.CONCLUSIONSTo date, there is a limited evidence base for all preventative strategies including IONM, RAS, PFP and TAI. These strategies are limited by either access (IONM, RAS and PFP) or acceptability (PFP and TAI), which are both key to the success of any intervention. The results of ongoing trials will serve to assess acceptability, while technological advancement may improve access to some of the aforementioned strategies.

01 Dec 2024·Techniques in Coloproctology

Peri-operative, oncological and functional outcomes of robotic versus transanal total mesorectal excision in patients with rectal cancer: A systematic review and meta-analysis

Review

Author: Ismail, A ; Alyamani, A A ; Mohamedahmed, A Y Y ; Wuheb, A A ; Eltyeb, H A ; Nnaji, M ; Zaman, S ; Yassin, N A

BACKGROUNDComparative outcomes of robotic low anterior resection (rTME) and trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer were evaluated.METHODSA systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies of rTME versus TaTME for low rectal cancer were included. Primary outcomes were postoperative complications, including anastomotic leak, surgical site infection, and Clavien-Dindo complication rate. Total operative time, conversion to open surgery, intra-operative blood loss, intensive therapy unit (ITU) and total hospital length of stay (LOS), oncological outcomes and functional outcomes were the other evaluated outcome parameters.RESULTSA total of 12 studies with a total number of 3025 patients divided between rTME (n = 1881) and TaTME (n = 1144) groups were included. There was no significant difference between the two groups for total operative time (P = 0.39), conversion to open surgery (P = 0.29) and intra-operative blood loss (P = 0.62). Clavien-Dindo ≥ 3 complication rate (P = 0.47), anastomotic leak (P = 0.89), rates of re-operation (P = 0.62) and re-admission (P = 0.92), R0 resections (P = 0.52), ITU LOS (P = 0.63) and total hospital LOS (P = 0.30) also showed similar results between the two groups. However, the rTME group had higher rates of total harvested lymph nodes (P = 0.04) and complete total mesorectal excision (TME) resections (P = 0.05). Albeit with a limited dataset, the Wexner and low anterior resection syndrome (LARS) scores showed better functional results in the rTME group compared with the TaTME group (P = 0.0009 and P = 0.00001, respectively).CONCLUSIONCompared with TaTME, rTME seems to provide better functional outcomes, higher lymph node yield and more complete TME resections with a similar post-operative complications profile.

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