Presentation Information
[JKS1-4]LARS Management: From Physiologic Assessment to Treatment
*Yuji Nishizawa1 (1. Department of Colorectal Surgery, National Cancer Center Hospital East, Japan)
With more sphincter-preserving surgery and improved rectal cancer survival, more patients worldwide live with low anterior resection syndrome (LARS). Access to assessment and treatment varies by healthcare system. We propose perioperative LARS management incorporating physiologic testing.
Preoperative counseling should explain LARS mechanisms and risk factors, including radiation, sex, and surgical procedure, with physiologic findings informing risk assessment. Information should also cover permanent stoma options, including abdominoperineal resection. Sphincter-preserving surgery may lead to LARS, whereas a permanent stoma may affect body image. Neither option provides better quality of life for all patients. Multidisciplinary shared decision-making should reflect patients' values and daily lives.
The Japanese Practice Guidelines for Fecal Incontinence provide a framework for assessing and treating incontinence associated with LARS. Serial LARS scores and a structured pathway can guide intervention. Initial management should be available at all institutions, with specialist referral when needed. Persistent symptoms or unclear mechanisms warrant consideration of anorectal manometry, rectal sensory testing, endoanal ultrasonography, or defecography.
Treatment includes dietary and medication adjustments, pelvic floor training and biofeedback, transanal irrigation, sacral neuromodulation, and, ultimately, stoma formation. Specialist collaboration is essential. Surgeons, functional specialists, nurses providing stoma and continence care, and rehabilitation staff should jointly select treatment based on symptoms, clinical and physiologic findings, and patient preferences, with continuing support through regional networks.
Preoperative counseling should explain LARS mechanisms and risk factors, including radiation, sex, and surgical procedure, with physiologic findings informing risk assessment. Information should also cover permanent stoma options, including abdominoperineal resection. Sphincter-preserving surgery may lead to LARS, whereas a permanent stoma may affect body image. Neither option provides better quality of life for all patients. Multidisciplinary shared decision-making should reflect patients' values and daily lives.
The Japanese Practice Guidelines for Fecal Incontinence provide a framework for assessing and treating incontinence associated with LARS. Serial LARS scores and a structured pathway can guide intervention. Initial management should be available at all institutions, with specialist referral when needed. Persistent symptoms or unclear mechanisms warrant consideration of anorectal manometry, rectal sensory testing, endoanal ultrasonography, or defecography.
Treatment includes dietary and medication adjustments, pelvic floor training and biofeedback, transanal irrigation, sacral neuromodulation, and, ultimately, stoma formation. Specialist collaboration is essential. Surgeons, functional specialists, nurses providing stoma and continence care, and rehabilitation staff should jointly select treatment based on symptoms, clinical and physiologic findings, and patient preferences, with continuing support through regional networks.