Our Summary

This research paper discusses a common issue that happens after rectal cancer surgery called Low Anterior Resection Syndrome (LARS). This syndrome interferes with a person’s quality of life because it causes problems like loss of bowel control and difficulties with urination. Up to 90% of patients who have a specific kind of rectal surgery might experience this syndrome. The reasons why this happens are complicated and not completely understood, but could include things like damage from radiation before surgery, the need for a certain kind of temporary surgery to protect the bowel, injuries to the muscles that control bowel movements, nerve damage, and changes in how the left side of the colon works. There are different treatments that can help manage the symptoms of LARS, but there’s no one-size-fits-all treatment or way to decide who should get what treatment. The paper reviews these different treatment options for people who have had rectal surgery.

FAQs

  1. What is Low Anterior Resection Syndrome (LARS) and what are its symptoms?
  2. What are the potential causes of LARS following rectal cancer surgery?
  3. What are the different treatment options for managing the symptoms of LARS?

Doctor’s Tip

A helpful tip a doctor might tell a patient about proctectomy is to be aware of the potential side effects, such as Low Anterior Resection Syndrome (LARS), and to discuss any concerns or symptoms with their healthcare provider. It’s important for patients to communicate openly with their doctor about any changes in bowel habits or difficulties with urination, as early intervention and treatment can help improve quality of life. Additionally, following a healthy diet, staying hydrated, and maintaining regular exercise can also help manage symptoms and promote overall well-being after proctectomy surgery.

Suitable For

Patients who have undergone rectal surgery, particularly low anterior resection surgery, are typically recommended proctectomy if they are experiencing significant symptoms of Low Anterior Resection Syndrome (LARS) that significantly impact their quality of life. These symptoms may include frequent bowel movements, urgency, fecal incontinence, and difficulty with bowel movements.

Patients who have tried conservative treatments for LARS, such as dietary modifications, medications, and physical therapy, without success may also be recommended proctectomy. Additionally, patients who have complications from LARS, such as anal stricture or rectovaginal fistula, may require proctectomy for resolution of these issues.

It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if proctectomy is the best course of action for their individual situation.

Timeline

Before proctectomy:

  1. Diagnosis of rectal cancer: The patient may experience symptoms such as rectal bleeding, changes in bowel habits, abdominal pain, and weight loss. This leads to further testing and a diagnosis of rectal cancer.

  2. Pre-surgery preparations: The patient will undergo various tests and evaluations to determine the extent of the cancer and if surgery is the best treatment option. They may also meet with a surgeon and other healthcare providers to discuss the procedure and potential risks.

  3. Proctectomy surgery: The patient undergoes the surgical removal of the rectum and possibly part of the colon. This surgery can be done through open surgery or minimally invasive techniques such as laparoscopy or robotic surgery.

After proctectomy:

  1. Recovery in the hospital: The patient will stay in the hospital for a few days to recover from the surgery. They may experience pain, fatigue, and changes in bowel function during this time.

  2. Post-surgery follow-up: The patient will have regular follow-up appointments with their healthcare team to monitor their recovery, manage any complications, and discuss further treatment options such as chemotherapy or radiation therapy.

  3. Management of LARS: If the patient develops Low Anterior Resection Syndrome (LARS) after surgery, they may experience symptoms such as increased frequency of bowel movements, urgency, and incontinence. They will work with their healthcare team to develop a personalized treatment plan that may include dietary changes, medications, pelvic floor exercises, and possibly surgical interventions.

Overall, the patient will go through a period of recovery and adjustment after proctectomy as they navigate the physical and emotional challenges of living with a changed bowel function. It is important for patients to communicate openly with their healthcare team and seek support from loved ones to help them cope with these changes.

What to Ask Your Doctor

  1. What is a proctectomy and why is it being recommended for me?

  2. What are the potential risks and complications associated with a proctectomy?

  3. How will a proctectomy affect my bowel function and quality of life?

  4. What are the chances of developing Low Anterior Resection Syndrome (LARS) after a proctectomy?

  5. What are the symptoms of LARS and how can they be managed?

  6. Are there any specific lifestyle changes or dietary modifications I should make after a proctectomy?

  7. What are the different treatment options available for managing LARS symptoms?

  8. How will my follow-up care be managed after a proctectomy?

  9. Are there any long-term effects or considerations I should be aware of after a proctectomy?

  10. Are there any support groups or resources available for individuals who have undergone a proctectomy and are experiencing LARS symptoms?

Reference

Authors: Cirera de Tudela A, Marinello F, Espín Basany E. Journal: Cir Esp (Engl Ed). 2025 Apr;103(4):237-243. doi: 10.1016/j.cireng.2025.01.001. Epub 2025 Jan 22. PMID: 39855552