Lower anterior resection

Lower anterior resection
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A lower anterior resection, formally known as anterior resection of the rectum and anterior excision of the rectum or simply anterior resection (less precise), is a common surgery for rectal cancer and occasionally is performed to remove a diseased or ruptured portion of the intestine in cases of diverticulitis. It is commonly abbreviated as LAR.

LARs are for cancer in the proximal (upper) two-thirds of the rectum which lends itself well to resection while leaving the rectal sphincter intact.

LARs, generally, give a better quality of life than abdominoperineal resections (APRs). Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible. APRs lead to a permanent colostomy and do not spare the sphincters.

Low anterior resection syndrome (LARS) comprises a collection of symptoms mainly affecting patients after surgery for rectal cancer characterized by fecal incontinence (stool and gases), fecal urgency, frequent bowel movements and bowel fragmentation. These symptoms have a major impact on the quality of life of patients and several studies have tried to establish the prevalence and severity of this syndrome as well as its correlation with epidemiological factors. So far, neoadjuvant therapy for rectal cancer, total versus partial mesorectal excision, patient age <64, anastomotic leak and female sex have been identified as predisposing factors for severity and duration of LARS symptoms. Presence of ileostomy or time to ileostomy closure is not associated with the development of this syndrome.

Many of the symptoms of LAR Syndrome improve over a period of many months. The nerves that control the natural contractions of the colon and rectum run along the colon and can be damaged or cut during the surgery. After such damage, the nerves can regrow, but only slowly.

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