Postoperative Bowel Function After Anal Sphincter-Preserving Rectal Cancer Surgery: Risks Factors, Diagnostic Modalities, and Management

Abstract

Low anterior resection syndrome (LARS) refers to a disturbance of bowel function that commonly manifests within 1 month after rectal cancer surgery. A low level of anastomosis and chemoradiotherapy have been consistently found to be risk factors for developing LARS. Thorough history taking and physical examination with adjunctive procedures are essential when evaluating patients with LARS. Anorectal manometry, fecoflowmetry, and validated questionnaires are important tools for assessing the quality of life of patients with LARS. Conservative management (medical, physiotherapy, transanal irrigation), invasive procedures (neuromodulation), and multimodal therapy are the mainstay of treatment for patients with LARS. A stoma could be considered when other treatment modalities have failed. An initial meticulous surgical procedure for rectal cancer, creation of a neorectal reservoir during anastomosis, and proper exercise of the anal sphincter muscle (Kegel’s maneuver) are essential to combat LARS. Pretreatment counseling is a crucial step for patients who have risk factors for developing LARS.

Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer

“…If the severities of the symptoms persist for more than 2 years, permanent stoma formation should be carefully considered after patient's consent. [ 87 ]…”

Optimizing sacral neuromodulation for low anterior resection syndrome: learning from our experience

“…There are numerous treatment proposals but still no gold standard, probably due to the great variation in symptoms and severity between patients (dependent on clinical factors, radiotherapy, type of surgery, etc.) [11]. SNM has been used with success in patients with LARS and has been proposed as an effective treatment in various studies [5,12].…”

“…Deterioration of anorectal function secondary to preoperative chemoradiation for rectal cancer has been described as an important adverse effect that can reduce resting and squeeze anal pressures and adversely affect continence and quality of life scores. Our patients followed long‐course preoperative chemoradiation that can affect the myenteric plexus, inhibit impulse conduction and directly damage sphincter structures in very low cancers, causing fibrosis [11].…”

The Impact of COVID-19 on Gastrointestinal Motility Testing in Asia and Europe

“…Oesophageal manometry and catheter-based pH monitoring are important preoperative tests for oesophageal achalasia and refractory gastroesophageal reflux disease [ 4 , 12 , 13 , 14 ]. In addition, anal manometry is performed pre-operatively for certain anal conditions, and if not performed it may affect postoperative risk [ 15 ]. Delayed testing results in a medical and social disadvantage that prevents patients from receiving appropriate treatment.…”