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Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807741
DOI: 10.1055/s-0045-1807741
Review Article
Low Anterior Resection Syndrome Evaluation and Management
Abstract
Low anterior resection syndrome (LARS) is a constellation of symptoms consisting of stool or flatus incontinence, urgency, and/or clustering of bowel movements. Up to 80% of patients experience these symptoms after sphincter-sparing surgery for rectal cancer with concomitant decrease in quality of life. Multiple measurement tools have been developed and different treatment options have been explored. The purpose of this review was to evaluate LARS assessment tools, treatment options, and the supporting evidence for these strategies. We performed a literature review related to the evaluation and treatment of LARS, and ongoing clinical trials up to 2024 were reviewed. We found the definition of LARS was recently revised, with current validated diagnostic tools lagging behind this update. First-line treatment includes optimizing bowel habits, dietary changes, and medications. Second-line treatment includes pelvic floor rehabilitation or transanal irrigation. Third-line treatment includes sacral nerve stimulation or posterior tibial nerve stimulation before the discussion of antegrade enemas or permanent stoma creation. In summary, LARS remains a challenging symptomatic disorder to capture and treat effectively. There are opportunities for better standardization of preoperative education, evaluation, and escalation of treatment strategies. Further investigation into psychosocial and patient support adjuncts need to be developed. Continued research will help to refine and develop a clear treatment algorithm.
Publication History
Article published online:
16 April 2025
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References
- 1 Jiang Y, Yuan H, Li Z. et al. Global pattern and trends of colorectal cancer survival: a systematic review of population-based registration data. Cancer Biol Med 2021; 19 (02) 175-186
- 2 Lundberg FE, Birgisson H, Johannesen TB. et al. Survival trends in patients diagnosed with colon and rectal cancer in the nordic countries 1990-2016: The NORDCAN survival studies. Eur J Cancer 2022; 172: 76-84 . Accessed April 1, 2025 at: https://doi.org/10.1016/j.ejca.2022.05.032
- 3 American Cancer Society. Survival rates for colorectal cancer. 2024 . Accessed September 1, 2024 at: https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html
- 4 Kapiteijn E, Marijnen CA, Nagtegaal ID. ,et al.; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345 (09) 638-646
- 5 Marwan K, Staples MP, Thursfield V, Bell SW. The rate of abdominoperineal resections for rectal cancer in the state of Victoria, Australia: a population-based study. Dis Colon Rectum 2010; 53 (12) 1645-1651
- 6 van Gijn W, Marijnen CA, Nagtegaal ID. ,et al.; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011; 12 (06) 575-582
- 7 Bolton WS, Chapman SJ, Corrigan N. et al. The incidence of low anterior resection syndrome as assessed in an International Randomized Controlled Trial (MRC/NIHR ROLARR). Ann Surg 2021; 274 (06) e1223-e1229
- 8 Chen TY-T, Wiltink LM, Nout RA. et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer 2015; 14 (02) 106-114
- 9 Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, Sangkhathat S. Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients. Asian J Surg 2016; 39 (04) 225-231
- 10 Keane C, Fearnhead NS, Bordeianou L. ,et al.; LARS International Collaborative Group. International consensus definition of low anterior resection syndrome. Colorectal Dis 2020; 22 (03) 331-341
- 11 Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol 2012; 13 (09) e403-e408
- 12 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 (05) 922-928
- 13 Dulskas A, Miliauskas P, Tikuisis R, Escalante R, Samalavicius NE. The functional results of radical rectal cancer surgery: review of the literature. Acta Chir Belg 2016; 116 (01) 1-10
- 14 Battersby NJ, Juul T, Christensen P. ,et al.; United Kingdom Low Anterior Resection Syndrome Study Group. Predicting the risk of bowel-related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis Colon Rectum 2016; 59 (04) 270-280
- 15 Bondeven P, Emmertsen KJ, Laurberg S, Pedersen BG. Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery. Eur J Surg Oncol 2015; 41 (11) 1493-1499
- 16 Croese AD, Lonie JM, Trollope AF, Vangaveti VN, Ho Y-H. A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors. Int J Surg 2018; 56: 234-241
- 17 Hughes DL, Cornish J, Morris C. LARRIS Trial Management Group. Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome. Int J Colorectal Dis 2017; 32 (05) 691-697
- 18 Emmertsen KJ, Laurberg S. Rectal Cancer Function Study Group. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 2013; 100 (10) 1377-1387
- 19 Downing A, Glaser AW, Finan PJ. et al. Functional outcomes and health-related quality of life after curative treatment for rectal cancer: a population-level study in England. Int J Radiat Oncol Biol Phys 2019; 103 (05) 1132-1142
- 20 Sturiale A, Martellucci J, Zurli L. et al. Long-term functional follow-up after anterior rectal resection for cancer. Int J Colorectal Dis 2017; 32 (01) 83-88
- 21 Joseph DA, Johnson CJ, White A, Wu M, Coleman MP. Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD-2 study. Cancer 2017; 123 (Suppl. 24) 5037-5058
- 22 Christensen P, Im Baeten C, Espín-Basany E. ,et al.; MANUEL Project Working Group. Management guidelines for low anterior resection syndrome - the MANUEL project. Colorectal Dis 2021; 23 (02) 461-475
- 23 van der Heijden JAG, Thomas G, Caers F, van Dijk WA, Slooter GD, Maaskant-Braat AJG. What you should know about the low anterior resection syndrome - Clinical recommendations from a patient perspective. Eur J Surg Oncol 2018; 44 (09) 1331-1337
- 24 Bordeianou LG, Thorsen AJ, Keller DS. et al. The American society of colon and Rectal Surgeons clinical practice guidelines for the management of fecal incontinence. Dis Colon Rectum 2023; 66 (05) 647-661
- 25 Meng L-H, Mo X-W, Yang B-Y. et al. To explore the pathogenesis of anterior resection syndrome by magnetic resonance imaging rectal defecography. World J Gastrointest Surg 2024; 16 (02) 529-538
- 26 Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993; 36 (01) 77-97
- 27 Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut 1999; 44 (01) 77-80
- 28 Akizuki E, Okita K, Noda A. et al. Clinical utility and characteristics of the LARS score compared to the CCIS. World J Surg 2022; 46 (04) 925-932
- 29 Chen TY-T, Emmertsen KJ, Laurberg S. What are the best questionnaires to capture anorectal function after surgery in rectal cancer?. Curr Colorectal Cancer Rep 2015; 11 (01) 37-43
- 30 Temple LK, Bacik J, Savatta SG. et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 2005; 48 (07) 1353-1365
- 31 Liapi A, Mavrantonis C, Lazaridis P. et al. Validation and comparative assessment of low anterior resection syndrome questionnaires in Greek rectal cancer patients. Ann Gastroenterol 2019; 32 (02) 185-192
- 32 Quezada-Diaz FF, Elfeki H, Emmertsen KJ. et al. Comparative analysis of the Memorial Sloan Kettering Bowel Function Instrument and the Low Anterior Resection Syndrome Questionnaire for assessment of bowel dysfunction in rectal cancer patients after low anterior resection. Colorectal Dis 2021; 23 (02) 451-460
- 33 Ribas Y, Aguilar F, Jovell-Fernández E, Cayetano L, Navarro-Luna A, Muñoz-Duyos A. Clinical application of the LARS score: results from a pilot study. Int J Colorectal Dis 2017; 32 (03) 409-418
- 34 Al-Saidi AMA, Verkuijl SJ, Hofker S, Trzpis M, Broens PMA. How should the low anterior resection syndrome score be interpreted?. Dis Colon Rectum 2020; 63 (04) 520-526
- 35 Juul T, Elfeki H, Christensen P, Laurberg S, Emmertsen KJ, Bager P. Normative data for the low anterior resection syndrome score (LARS score). Ann Surg 2019; 269 (06) 1124-1128
- 36 Aaronson NK, Ahmedzai S, Bergman B. et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85 (05) 365-376
- 37 Brazier JE, Harper R, Jones NM. et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992; 305 (6846) 160-164
- 38 Apolone G, Filiberti A, Cifani S, Ruggiata R, Mosconi P. Evaluation of the EORTC QLQ-C30 questionnaire: a comparison with SF-36 Health Survey in a cohort of Italian long-survival cancer patients. Ann Oncol 1998; 9 (05) 549-557
- 39 Kuenstner S, Langelotz C, Budach V, Possinger K, Krause B, Sezer O. The comparability of quality of life scores. a multitrait multimethod analysis of the EORTC QLQ-C30, SF-36 and FLIC questionnaires. Eur J Cancer 2002; 38 (03) 339-348
- 40 Battersby NJ, Bouliotis G, Emmertsen KJ. ,et al.; UK and Danish LARS Study Groups. Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score. Gut 2018; 67 (04) 688-696
- 41 Dalsgaard P, Emmertsen KJ, Mekhael M, Laurberg S, Christensen P. Nurse-led standardized intervention for low anterior resection syndrome. A population-based pilot study. Colorectal Dis 2021; 23 (02) 434-443
- 42 Yoon BJ, Oh HK, Lee J. et al. Effects of probiotics on bowel function restoration following ileostomy closure in rectal cancer patients: a randomized controlled trial. Colorectal Dis 2021; 23 (04) 901-910
- 43 Bliss DZ, Savik K, Jung HJG, Whitebird R, Lowry A, Sheng X. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health 2014; 37 (05) 367-378
- 44 Hallgren T, Fasth S, Delbro DS, Nordgren S, Öresland T, Hultén L. Loperamide improves anal sphincter function and continence after restorative proctocolectomy. Dig Dis Sci 1994; 39 (12) 2612-2618
- 45 Musial F, Enck P, Kalveram KT, Erckenbrecht JF. The effect of loperamide on anorectal function in normal healthy men. J Clin Gastroenterol 1992; 15 (04) 321-324
- 46 Popeskou SG, Roesel R, Faes S. et al. Ondansetron for low anterior resection syndrome (LARS): A double-blind, placebo-controlled, cross-over, randomized study. Ann Surg 2024; 279 (02) 196-202
- 47 Ryoo S-B, Park JW, Lee DW. et al. Anterior resection syndrome: a randomized clinical trial of a 5-HT3 receptor antagonist (ramosetron) in male patients with rectal cancer. Br J Surg 2021; 108 (06) 644-651
- 48 Atkinson W, Lockhart S, Whorwell PJ, Keevil B, Houghton LA. Altered 5-hydroxytryptamine signaling in patients with constipation- and diarrhea-predominant irritable bowel syndrome. Gastroenterology 2006; 130 (01) 34-43
- 49 Garsed K, Chernova J, Hastings M. et al. A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut 2014; 63 (10) 1617-1625
- 50 Matsueda K, Harasawa S, Hongo M, Hiwatashi N, Sasaki D. A randomized, double-blind, placebo-controlled clinical trial of the effectiveness of the novel serotonin type 3 receptor antagonist ramosetron in both male and female Japanese patients with diarrhea-predominant irritable bowel syndrome. Scand J Gastroenterol 2008; 43 (10) 1202-1211
- 51 Pape E, Decoene E, Debrauwere M. ,et al.; Belgian LARS Collaborative Group. Information and counselling needs of patients with major low anterior resection syndrome: A qualitative study. J Clin Nurs 2023; 32 (7-8): 1240-1250
- 52 Sun V, Grant M, McMullen CK. et al. From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies. Support Care Cancer 2014; 22 (06) 1563-1570
- 53 Näsvall P, Dahlstrand U, Löwenmark T, Rutegård J, Gunnarsson U, Strigård K. Quality of life in patients with a permanent stoma after rectal cancer surgery. Qual Life Res 2017; 26 (01) 55-64
- 54 Trenti L, Galvez A, Biondo S. et al. Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: A cross-sectional study. Eur J Surg Oncol 2018; 44 (07) 1031-1039
- 55 Yau T, Watkins D, Cunningham D, Barbachano Y, Chau I, Chong G. Longitudinal assessment of quality of life in rectal cancer patients with or without stomas following primary resection. Dis Colon Rectum 2009; 52 (04) 669-677
- 56 Faury S, Koleck M, Foucaud J, M'Bailara K, Quintard B. Patient education interventions for colorectal cancer patients with stoma: A systematic review. Patient Educ Couns 2017; 100 (10) 1807-1819 . Accessed April 1, 2025 at: https://doi.org/10.1016/j.pec.2017.05.034
- 57 Herrinton LJ, Altschuler A, McMullen CK. et al. Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery. CA Cancer J Clin 2016; 66 (05) 387-397
- 58 Pape E, Vlerick I, Van Nieuwenhove Y. et al. Experiences and needs of patients with rectal cancer confronted with bowel problems after stoma reversal: A systematic review and thematic-synthesis. Eur J Oncol Nurs 2021; 54: 102018
- 59 Abelson JS, Chait A, Shen MJ, Charlson M, Dickerman A, Yeo H. Coping strategies among colorectal cancer patients undergoing surgery and the role of the surgeon in mitigating distress: A qualitative study. Surgery 2019; 165 (02) 461-468 . Accessed April 1, 2025 at: https://doi.org/10.1016/j.surg.2018.06.005
- 60 Garfinkle R, Wong-Chong N, Petrucci A. et al. Assessing the readability, quality and accuracy of online health information for patients with low anterior resection syndrome following surgery for rectal cancer. Colorectal Dis 2019; 21 (05) 523-531
- 61 Kim KH, Yu CS, Yoon YS, Yoon SN, Lim S-B, Kim JC. Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery. Dis Colon Rectum 2011; 54 (09) 1107-1113
- 62 Hoff Brækken I, Majida M, Engh ME, Bø K. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial. Obstet Gynecol 2010; 115 (2 Pt 1): 317-324
- 63 Scott KM. Pelvic floor rehabilitation in the treatment of fecal incontinence. Clin Colon Rectal Surg 2014; 27 (03) 99-105
- 64 Enck P, Van der Voort IR, Klosterhalfen S. Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterol Motil 2009; 21 (11) 1133-1141
- 65 Damon H, Siproudhis L, Faucheron J-L. ,et al.; Oralia Trial Group. Perineal retraining improves conservative treatment for faecal incontinence: a multicentre randomized study. Dig Liver Dis 2014; 46 (03) 237-242
- 66 Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J. Conservative Management of Fecal Incontinence in Adults Committee of the International Consultation on Incontinence. Management of fecal incontinence in adults. Neurourol Urodyn 2010; 29 (01) 199-206
- 67 Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y. Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life?. Colorectal Dis 2012; 14 (10) 1231-1237
- 68 Pager CK, Solomon MJ, Rex J, Roberts RA. Long-term outcomes of pelvic floor exercise and biofeedback treatment for patients with fecal incontinence. Dis Colon Rectum 2002; 45 (08) 997-1003
- 69 Asnong A, D'Hoore A, Van Kampen M. et al. The role of pelvic floor muscle training on low anterior resection syndrome: a multicenter randomized controlled trial. Ann Surg 2022; 276 (05) 761-768
- 70 Bosch N, Kalkdijk-Dijkstra A, van Westreenen H. et al. Pelvic floor rehabilitation after rectal cancer surgery one-year follow-up of a multicenter randomized clinical trial (FORCE trial). Ann Surg 2024; 281: 235-242
- 71 Lin YH, Yang HY, Hung SL. et al. Effects of pelvic floor muscle exercise on faecal incontinence in rectal cancer patients after stoma closure. Eur J Cancer Care (Engl) 2016; 25 (03) 449-457
- 72 van der Heijden J, Kalkdijk-Dijkstra A, Pierie J. et al. Pelvic floor rehabilitation after rectal cancer surgery: A multicenter randomized clinical trial (FORCE trial). Ann Surg 2022; 276: 38-45
- 73 Hetzer FH, Bieler A, Hahnloser D, Löhlein F, Clavien P-A, Demartines N. Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. Br J Surg 2006; 93 (11) 1411-1417
- 74 Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995; 346 (8983) 1124-1127 . Accessed April 1, 2025 at: https://doi.org/10.1016/S0140-6736(95)91799-3
- 75 de Miguel Valencia MJ, Cabasés Hita JM, Sánchez Iriso E. et al. Long-term cost-effectiveness analysis of sacral neuromodulation in the treatment of severe faecal incontinence. Colorectal Dis 2023; 25 (09) 1821-1831
- 76 Carrington EV, Evers J, Grossi U. et al. A systematic review of sacral nerve stimulation mechanisms in the treatment of fecal incontinence and constipation. Neurogastroenterol Motil 2014; 26 (09) 1222-1237
- 77 D'Hondt M, Nuytens F, Kinget L, Decaestecker M, Borgers B, Parmentier I. Sacral neurostimulation for low anterior resection syndrome after radical resection for rectal cancer: evaluation of treatment with the LARS score. Tech Coloproctol 2017; 21 (04) 301-307
- 78 Marinello F, Fraccalvieri D, Planellas P. et al. Sacral neuromodulation in patients with low anterior resection syndrome: The SANLARS randomized clinical trial. Dis Colon Rectum 2024; 67 (03) 435-447
- 79 Rubio-Perez I, Saavedra J, Marijuan JL, Pascual-Miguelañez I. Optimizing sacral neuromodulation for low anterior resection syndrome: learning from our experience. Colorectal Dis 2020; 22 (12) 2146-2154
- 80 Schiano di Visconte M, Santoro GA, Cracco N. et al. Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up. Tech Coloproctol 2018; 22 (02) 97-105
- 81 Mege D, Meurette G, Vitton V. ,et al.; Club NEMO. Sacral nerve stimulation can alleviate symptoms of bowel dysfunction after colorectal resections. Colorectal Dis 2017; 19 (08) 756-763
- 82 Croese AD, Whiting S, Vangaveti VN, Ho YH. Using sacral nerve modulation to improve continence and quality of life in patients suffering from low anterior resection syndrome. ANZ J Surg 2018; 88 (11) E787-E791
- 83 Wexner SD, Coller JA, Devroede G. et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg 2010; 251 (03) 441-449
- 84 Hernández-Hernández D, Padilla-Fernández B, Castro Romera M, Hess Medler S, Castro-Díaz D. Long-term outcomes of sacral nerve stimulation in pelvic floor dysfunctions. Int Neurourol J 2021; 25 (04) 319-326
- 85 Vigorita V, Rausei S, Troncoso Pereira P. et al. A pilot study assessing the efficacy of posterior tibial nerve stimulation in the treatment of low anterior resection syndrome. Tech Coloproctol 2017; 21 (04) 287-293
- 86 Govaert B, Pares D, Delgado-Aros S, La Torre F, Van Gemert WG, Baeten CG. A prospective multicentre study to investigate percutaneous tibial nerve stimulation for the treatment of faecal incontinence. Colorectal Dis 2010; 12 (12) 1236-1241
- 87 van der Pal F, van Balken MR, Heesakkers JP, Debruyne FM, Bemelmans BL. Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary?. BJU Int 2006; 97 (03) 547-550
- 88 Finazzi-Agrò E, Rocchi C, Pachatz C. et al. Percutaneous tibial nerve stimulation produces effects on brain activity: study on the modifications of the long latency somatosensory evoked potentials. Neurourol Urodyn 2009; 28 (04) 320-324
- 89 Cuicchi D, Di Fabio F, Guido A. et al. Randomized pilot trial of percutaneous posterior tibial nerve stimulation versus medical therapy for the treatment of low anterior resection syndrome: one-year follow-up. Dis Colon Rectum 2020; 63 (12) 1602-1609
- 90 Enriquez-Navascues JM, Labaka-Arteaga I, Aguirre-Allende I. et al. A randomized trial comparing transanal irrigation and percutaneous tibial nerve stimulation in the management of low anterior resection syndrome. Colorectal Dis 2020; 22 (03) 303-309
- 91 Marinello FG, Jiménez LM, Talavera E. et al. Percutaneous tibial nerve stimulation in patients with severe low anterior resection syndrome: randomized clinical trial. Br J Surg 2021; 108 (04) 380-387
- 92 Christensen P, Olsen N, Krogh K, Bacher T, Laurberg S. Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation. Dis Colon Rectum 2003; 46 (01) 68-76
- 93 Ausili E, Marte A, Brisighelli G. et al. Short versus mid-long-term outcome of transanal irrigation in children with spina bifida and anorectal malformations. Childs Nerv Syst 2018; 34 (12) 2471-2479
- 94 Martellucci J, Sturiale A, Bergamini C. et al. Role of transanal irrigation in the treatment of anterior resection syndrome. Tech Coloproctol 2018; 22 (07) 519-527
- 95 Rosen H, Robert-Yap J, Tentschert G, Lechner M, Roche B. Transanal irrigation improves quality of life in patients with low anterior resection syndrome. Colorectal Dis 2011; 13 (10) e335-e338
- 96 Rosen HR, Boedecker C, Fürst A, Krämer G, Hebenstreit J, Kneist W. “Prophylactic” transanal irrigation (TAI) to prevent symptoms of low anterior resection syndrome (LARS) after rectal resection: results at 12-month follow-up of a controlled randomized multicenter trial. Tech Coloproctol 2020; 24 (12) 1247-1253
- 97 Christensen P, Krogh K, Buntzen S, Payandeh F, Laurberg S. Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence. Dis Colon Rectum 2009; 52 (02) 286-292
- 98 Pieniowski EHA, Bergström CM, Nordenvall CAM. et al. A randomized controlled clinical trial of transanal irrigation versus conservative treatment in patients with low anterior resection syndrome after rectal cancer surgery. Ann Surg 2023; 277 (01) 30-37
- 99 McCutchan GM, Hughes D, Davies Z, Torkington J, Morris C, Cornish JA. LARRIS Trial Management Group. Acceptability and benefit of rectal irrigation in patients with low anterior resection syndrome: a qualitative study. Colorectal Dis 2017; 20 (03) O76-O84
- 100 King SK, Sutcliffe JR, Southwell BR, Chait PG, Hutson JM. The antegrade continence enema successfully treats idiopathic slow-transit constipation. J Pediatr Surg 2005; 40 (12) 1935-1940 . Accessed April 1, 2025 at: https://doi.org/10.1016/j.jpedsurg.2005.08.011
- 101 Siminas S, Losty PD. Current surgical management of pediatric idiopathic constipation: a systematic review of published studies. Ann Surg 2015; 262 (06) 925-933
- 102 Didailler R, Denost Q, Loughlin P. et al. Antegrade enema after total mesorectal excision for rectal cancer: The last chance to avoid definitive colostomy for refractory low anterior resection syndrome and fecal incontinence. Dis Colon Rectum 2018; 61 (06) 667-672
- 103 Dulskas A, Smolskas E, Kildusiene I, Samalavicius NE. Treatment possibilities for low anterior resection syndrome: a review of the literature. Int J Colorectal Dis 2018; 33 (03) 251-260
- 104 Martellucci J. Low anterior resection syndrome: a treatment algorithm. Dis Colon Rectum 2016; 59 (01) 79-82
- 105 Dinnewitzer A, Jäger T, Nawara C, Buchner S, Wolfgang H, Öfner D. Cumulative incidence of permanent stoma after sphincter preserving low anterior resection of mid and low rectal cancer. Dis Colon Rectum 2013; 56 (10) 1134-1142
- 106 Lindgren R, Hallböök O, Rutegård J, Sjödahl R, Matthiessen P. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 2011; 54 (01) 41-47
- 107 Thomas F, Menahem B, Lebreton G, Bouhier-Leporrier K, Dejardin O, Alves A. Permanent stoma after sphincter preservation for rectal cancer. A situation that occurs more often than you might think. Front Oncol 2023; 12: 1056314
- 108 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 (05) 922-928
- 109 Srinivas J, Ivatury MM. What is the right way to assess quality of life?. University of Texas at Austin; 2024
- 110 Garfinkle R, Loiselle CG, Park J. et al. Development and evaluation of a patient-centred program for low anterior resection syndrome: protocol for a randomized controlled trial. BMJ Open 2020; 10 (05) e035587
- 111 Moon J, Monton O, Smith A. et al. Interactive online informational and peer support application for patients with low anterior resection syndrome: patient survey and protocol for a multicentre randomized controlled trial. Colorectal Dis 2021; 23 (05) 1248-1257
- 112 Sacomori C, Lorca LA, Martinez-Mardones M. et al. A randomized clinical trial to assess the effectiveness of pre- and post-surgical pelvic floor physiotherapy for bowel symptoms, pelvic floor function, and quality of life of patients with rectal cancer: CARRET protocol. Trials 2021; 22 (01) 448
- 113 Gillis C, Fenton TR, Sajobi TT. et al. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin Nutr 2019; 38 (03) 1053-1060
- 114 Molenaar CJL, Minnella EM, Coca-Martinez M. et al. PREHAB Study Group. Effect of multimodal prehabilitation on reducing postoperative complications and enhancing functional capacity following colorectal cancer surgery: the PREHAB randomized clinical trial. JAMA Surg 2023; 158 (06) 572-581
- 115 National Library of Medicine (US). Comparison of transanal irrigation and glycerol suppositories in treatment of low anterior resection syndrome. A multicentre randomised controlled trial. Accessed April 1, 2025 at: https://clinicaltrials.gov/study/NCT04087421
- 116 National Library of Medicine (US). Transanal irrigation for the management of low anterior resection syndrome (LARS). A multicenter crossover randomized controlled trial. Accessed April 1, 2025 at: https://clinicaltrials.gov/study/NCT05007015
- 117 National Library of Medicine (US). High-volume and low-volume water transanal irrigation for the management of low anterior resection syndrome. A crossover randomized controlled clinical trial. Accessed April 1, 2025 at: https://clinicaltrials.gov/study/NCT05245331
- 118 National Library of Medicine (US). The safety and efficacy of transanal irrigation in patients with sleep disturbance from low anterior resection syndrome after rectal cancer surgery. A multicenter prospective randomized controlled trial (TraLARS). Accessed April 1, 2025 at: https://clinicaltrials.gov/study/NCT06222255
- 119 National Library of Medicine (US). Impact of early postoperative treatment with posterior tibial nerve stimulation on the incidence and duration of low anterior rectal resection syndrome. Accessed April 1, 2025 at: https://clinicaltrials.gov/study/NCT05368168