Anterior Resection Syndrome Following Sphincter-preserving Surgery

One of the main aims when carrying out surgery for rectal cancer is to avoid patients ending up with a permanent stoma. The current standard operation for resection of the rectum is an anterior resection. A large proportion of the patients undergoing this procedure develop anterior resection syndrome, with significant alteration of their bowel habit, including urgency, incontinence and unpredictability. Many definitions for this problem have been used and until recently there was no specifically designed tool for measuring it. There has never been a large scale study in the UK to tell us how common the problem is. A meta-analysis combining results from small studies show marked variation in the frequency of symptoms ranging from 285%, mainly because of the different methods of assessment used in the studies.

The LARS score was recently developed by a research group in Denmark. Their results show that 45.9% of patients had major LARS at 12 months following surgery. This is nearly half of all patients in their sample and clearly represents an important problem.

Anterior resection syndrome is known to have a negative effect on quality of life. It is a multifactorial condition and is increased in patients have chemotherapy and radiotherapy. There are treatments available and also in development which may help patients. However in clinical practice, patients are not routinely asked about their functional outcome and the effect that these symptoms can have on patients' lives is often not discussed. The urgent need for further research into the longterm functional effects of treatments for cancer has been acknowledged by the National Institute for Health and Care Excellence (NICE) and the National Cancer Survivorship Initiative.

Determining baseline prevalence in the UK and validating the LARS score will allow accurate preoperative counselling of patients about functional outcomes following surgery for rectal cancer. It will facilitate comparison between populations, further helping to determine risk factors and aiding in development of therapeutic interventions. An appreciation of the impact of anterior resection syndrome on postoperative quality of life will encourage routine assessment of functional outcomes in clinical practice, allowing identification of patients who may benefit from treatment.