Causes and management of LARS – the latest evidence explored

Rosen, H. et al (2023): Management of low anterior resection syndrome (LARS) following resection for rectal cancer. Cancers 2023, 15, 778.

Low anterior resection syndrome (LARS) is common. 60-80% of patients who undergo rectal resection (mostly for rectal cancer) experience symptoms which can have a significant impact on quality of life. This literature review explores the latest evidence behind the causes of LARS and the treatments on offer. We are pleased to see how transanal irrigation (TAI) is becoming more widely accepted and can treat these symptoms effectively, with a growing evidence-base.

Rosen et al (2023) recommend that patients are asked about LARS symptoms, so that they are identified and treated, at every follow-up and suggest that treatment follows a standardised treatment algorithm to control symptoms and improve quality of life.

Sue Frost, our Clinical Director, asked Dr Rosen about his latest publication and what it means for clinical practice. Dr Rosen says:

“In order to evaluate the present state of the art for the management of patients suffering from LARS following rectal resection, we performed a review of the literature.

It was striking to find an increasing awareness, as well as improved knowledge about the causes for this functional problem. Pelvic floor rehabilitation but-most of all- transanal irrigation has significantly improved the outcome for patients and should be kept in mind”.

Read the full paper here (open access) 

Table 1: LARS Symptoms & Consequences*

LARS is diagnosed when a patient has at least one of these symptoms following surgery, leading to at least one of the consequences/areas affected.

Unpredictable bowel functionEmptying difficultiesToilet dependence Mental & emotional wellbeing 
Altered stool consistencyUrgencyPreoccupation with bowel function Social & daily activities 
Increased stool frequencyIncontinenceDissatisfaction with bowels Relationships & intimacy 
Repeated painful stoolsSoilingStrategies & compromises Roles, commitments & responsibilities 

*Keane C, Fearnhead NS, Bordeianou LG et al; LARS International Collaborative Group. International consensus definition of low anterior resection syndrome. ANZ J Surg. 2020;90(3):300–307.