LAUSR

The constellation of symptoms including incontinence, stool frequency, urgency, and evacuatory dysfunction, deriving from anatomic and functional modifications after low anterior resection for rectal cancer is collectively referred to as Low Anterior Resection Syndrome (LARS). While on the diagnostic level a validated scoring system (LARS score) has been developed for the evaluation of its severity [1], the available therapeutic options are still suboptimal [2]. Recent studies have used the LARS score as the bowel dysfunction assessment tool in patient groups who did not undergo anterior resection. First of all, some data suggest that, in the general population aged between 50 and 79, 19% of females and 10% of males had a LARS score > 30 points, corresponding to a major LARS [3]. A similar prevalence (15%) was found in a reference population of 501 patients (significantly more frequent among women) not affected by colorectal cancer, thus also demonstrating an association between major LARS and worse scores in the evaluation of quality of life (QoL) [4]. When radical surgery is performed, functional outcomes can be influenced by the anastomotic technique chosen. A study showed a higher risk of faecal incontinence with handsewn coloanal than with stapled anastomosis; whereas, the mean LARS score was not statistically different between the two groups [5]. On the other hand, in the setting of an organpreserving strategy, 55 patients who underwent Transanal Endoscopic Microsurgery (TEM) for stage I rectal cancer reported major LARS in 29% of cases [6]. This value rises to 50% in the subgroup of patients undergoing TEM after neoadjuvant chemoradiotherapy (CRT) where this combined procedure can increase complications and morbidity especially if a completion Total Mesorectal Excision (TME) is required [7]. Furthermore, in a study comparing results in QoL between ‘Watch and Wait’ and the standard treatment for rectal cancer, a LARS score was also calculated when only CRT was performed [8]. Major LARS symptoms were present in 35.9% of these patients. Although the LARS score was developed and validated to assess the functional outcome after low anterior resection for rectal cancer, LARS-like symptoms also occur after colonic resections. Specifically, a recent study showed 20.6% and 15.7% of patients with major LARS after 287 rightsided colectomy and 230 left-sided colectomy, respectively, evaluated 1 year after surgery [9]. Also in this case, women are more significantly affected (21.7% vs 15.3%). In addition, van Heinsbergen et al. [10] assessed bowel function using the LARS score and impact on QoL in 1145 patients who underwent colonic resection for cancer. Authors found that the prevalence of major LARS was 21% after colectomy (20.4% after sigmoid resection, 14.3% after left hemicolectomy and 22.3% after right hemicolectomy). Female sex and the presence of diverting stoma were considered as the independent factors associated with major LARS in the multivariate analyses. In both studies, QoL was significantly impaired in patients who develop LARS. In light of the results of these recent studies, some considerations can be drawn. The percentage of patients affected by LARS after colonic resection appears to be similar to that of a “healthy” population (15–20%); whereas, it seems to increase in proportion to the invasiveness of the treatment for rectal cancer, namely when CRT (36%), CRT with TEM (50%) and LAR (up to 80%) were performed. Therefore, all patients undergoing the above-mentioned procedures should receive preoperative information about the risk of developing LARS-like complaints that could have a negative impact on their QoL. Furthermore, in addition to adequate oncologic follow-up, a careful follow-up of the bowel function by a validated scoring system (LARS score, Wexner score, * Roberto Peltrini [email protected]