Sharp G, Findlay N, Clark D, Hong J
Princess Alexandra Hospital, Brisbane, QLD, Australia.
Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia.
Tech Coloproctol. 2025 Feb 4;29(1):58. doi: 10.1007/s10151-024-03090-3.
Rectal cancer incidence is increasing. Low anterior resection is currently the gold standard surgical management. Postoperatively, patients may present with symptoms indicative of low anterior resection syndrome (LARS). LARS can be debilitating and is difficult to treat with low efficacy of treatment modalities. This systematic review aims to highlight the current evidence regarding LARS management.
Systematic review of Medline, Cochrane and Embase used the following terms: "low anterior resection syndrome" AND "management", "low anterior resection syndrome" AND "treatment". Articles that focus solely of low anterior resection syndrome management in patients > 18 years were included. Bias risk was assessed via the Newcastle-Ottawa quality assessment scale for cohort studies and the JBI critical appraisal tool for randomized controlled trials. Due to heterogeneity of methodology, no statistical analysis was performed.
Thirty-eight articles with a total of 1914 patients were included in this review. Ninety-five per cent underwent surgery for malignancy. Treatment options included pharmacology, pelvic floor rehabilitation (PFR), transanal irrigation (TAI), sacral nerve modulation (SNM), percutaneous tibial nerve stimulation (PTNS) and "treatment programs" starting from the least invasive procedures escalating to more invasive treatments upon failure. The most common published medical therapies report Ramoestron use; however, studies are low impact. PFR showed significant improvement in LARS mostly in those with symptoms of faecal incontinence. However, long-term outcomes are inconsistent. TAI supplies pseudo-continence with its greatest benefit reported in those with incomplete evacuation. TAI has significant short-term effects on LARS but little long-term effect. TAI is also associated with a significant drop-out rate. SNM's hypothesised benefit is extrapolated from non-LARS associated FI. Results show improvements in FI but a high rate of explantation. PTNS evidence suggests little if any significant LARS improvement. A single "stepwise programme" study reported that 77 per cent did not progress further than diet and medication. Little evidence suggests benefit regarding diet or acupuncture.
There is no consensus as to the optimal treatment strategy for LARS. LARS is multifactorial and requires sensitive discussion between patient and surgeon to address the most prominent symptom. It requires physical and psychological input. No single treatment option provides superior results. Treatment is based on symptom control and patient acceptance.
直肠癌发病率呈上升趋势。低位前切除术是目前手术治疗的金标准。术后，患者可能会出现提示低位前切除综合征（LARS）的症状。LARS会使人衰弱，且治疗方式疗效不佳，难以治疗。本系统评价旨在突出目前关于LARS管理的证据。
对Medline、Cochrane和Embase进行系统评价，使用以下检索词：“低位前切除综合征”和“管理”、“低位前切除综合征”和“治疗”。纳入仅关注18岁以上患者低位前切除综合征管理的文章。通过纽卡斯尔-渥太华队列研究质量评估量表和JBI随机对照试验关键评价工具评估偏倚风险。由于方法的异质性，未进行统计分析。
本评价纳入了38篇文章，共1914例患者。95%的患者因恶性肿瘤接受手术。治疗选择包括药理学、盆底康复（PFR）、经肛门冲洗（TAI）、骶神经调节（SNM）、经皮胫神经刺激（PTNS）以及“治疗方案”，从侵入性最小的程序开始，若失败则升级为侵入性更强的治疗。最常报道的药物治疗是使用雷莫司琼；然而，研究影响力较低。PFR在LARS方面显示出显著改善，主要是在那些有大便失禁症状的患者中。然而，长期结果并不一致。TAI提供假性控便，在排空不全的患者中报道的益处最大。TAI对LARS有显著的短期影响，但长期影响较小。TAI还与显著的退出率相关。SNM的假定益处是从与LARS无关的大便失禁推断而来。结果显示大便失禁有所改善，但取出率很高。PTNS的证据表明对LARS几乎没有显著改善。一项单一的“逐步方案”研究报告称，77%的患者进展未超过饮食和药物治疗。几乎没有证据表明饮食或针灸有益。
对于LARS的最佳治疗策略尚无共识。LARS是多因素的，需要患者和外科医生之间进行敏感的讨论，以解决最突出的症状。它需要身体和心理方面的投入。没有单一的治疗选择能提供卓越的效果。治疗基于症状控制和患者接受程度。
