Management guidelines for low anterior resection syndrome – the MANUEL project

Abstract

Aim Little is known about the pathophysiology of low anterior resection syndrome (LARS), and evidence concerning the management of patients diagnosed with this condition is scarce. The aim of the LARS Expert Advisory Panel was to develop practical guidance for healthcare professionals dealing with LARS. Method The ‘Management guidelines for low anterior resection syndrome’ (MANUEL) project was promoted by a team of eight experts in the assessment and management of patients with LARS. After a face‐to‐face meeting, a strategy was agreed to create a comprehensive, practical guide covering all aspects that were felt to be clinically relevant. Eight themes were decided upon and working groups established. Each working group generated a draft; these were collated by another collaborator into a manuscript, after a conference call. This was circulated among the collaborators, and it was revised following the comments received. A lay patient revised the manuscript, and contributed to a section containing a patient's perspective. The manuscript was again circulated and finalized. A final teleconference was held at the end of the project. Results The guidance covers all aspects of LARS management, from pathophysiology, to assessment and management. Given the lack of sound evidence and the often poor quality of the studies, most of the recommendations and conclusions are based on the opinions of the experts. Conclusions The MANUEL project provides an up‐to‐date practical summary of the available evidence concerning LARS, with useful directions for healthcare professional and patients suffering from this debilitating condition.

The trajectory of hope and loneliness in rectal cancer survivors with major low anterior resection syndrome: A qualitative study

“…Several studies confirm the use of a variety of self-care management strategies but do not go in depth about the hope that is associated with it (DeSnoo and Faithfull, 2006;Landers et al, 2012;Nikoletti et al, 2008;Reinwalds et al, 2017Reinwalds et al, , 2018Taylor and Bradshaw, 2013;Yin et al, 2018). Several treatment algorithms for LARS are available in literature (Christensen et al, 2021;Dulskas et al, 2018;Martellucci, 2016;McKenna, 2019;Nguyen and Chokshi, 2020) but it is crucial to focus on the individual nature of the symptoms and a personal approach of the patient and his environment.…”

Altered colonic motility is associated with low anterior resection syndrome, by Keane et al

“…gives an excellent overview of current evidence with practical guidelines for the management of LARS highlighting the crucial aspects of managing expectations and shared decision making with our patients [2].…”

The Risk Factors of Low Anterior Resection Syndrome After Colorectal Cancer Surgery Compared with the Last Decade Studies

“…CRC is the third most common cancer in the world, accounting for more than a third of all cancer cases, with an age-standardized rate of 7.7 per 100,000 [1][2][3][4]. With the advances in chemotherapy, radiotherapy, and surgical techniques, the long-term survival numbers are increasing after CRC surgery regardless of the rising incidences of these diseases [5][6][7]. The major surgical procedure for CRC involves abdominoperineal resection (APR or called as Mile's procedure) and low anterior resection (LAR) with preservation of sphincter muscles.…”

“…LARS generally consists of fecal incontinence, urgency, and incomplete evacuation or evacuation di culties. several articles reported the leakage of gas and stool, stool clustering, frequent bowel movements, evacuation, and urgency as the main complaints [1,7,16,[19][20][21]. LARS can have two types of symptoms, the rst type appears within 6-12 months after surgery, which is called short-term symptoms.…”

“…Hypermotility of the remnant colon can affect the manifestation of urge fecal incontinence. However, these kinds of coloplasty do not improve the quality of life (QoL) of LAR patients after CRC perfectly [7,18,19].…”