‘Big data exposes the tip of the LARS iceberg’

Review by Michelle Henderson

The recent ‘Big data exposes the tip of the LARS iceberg’ article by Nicola Fearnhead discusses the development of a novel scoring tool for low anterior resection syndrome (LARS).  

LARS describes a cluster of bowel related symptoms that may affect patients after surgery for bowel cancer. The current LARS score (Emmertsen and Lauerberg 2012) is an effective screening tool that identifies patients with minor and major LARS. 

Nicola adds how with increasing recognition of LARS, treatment options, which include transanal irrigation, have been evaluated and offer hope to many patients. Whilst interventions improve quality of life, this is not reflected in a changing LARS score. 

This latest international study involved patients, clinicians and allied health professionals. The process found 8 eight key symptoms and 8 key consequences of LARS, providing a basis for a new LARS score that incorporates scoring of consequences that impact quality of life. This paves the way for a more responsive longitudinal tool in the future (Keane et al 2020). 

Nicola discusses the limitations of this study and concludes the prevalence of LARS of 28% remains the ‘tip of the iceberg’ and that ‘cure for rectal cancer comes at a cost for many patients. 

Transanal irrigation can offer hope to patients with LARS. As healthcare professionals, we need to support patients along their journey, implementing the right treatment in a timely fashion. Using teaching aids, such as the Decision Guide, we can successfully initiate transanal irrigation – restoring the balance for patients between cure from rectal cancer and quality of life. 

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Emmertsen KJ, Laurberg S. 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. 2012;255:922e928. 

Keane C, Fearnhead NS, Bordeianou L, et al. International consensus definition of low anterior resection syndrome. Colorectal Dis. 2020;22:331e341.