Follow-up care and treatment of functional disorders after surgery for rectal cancer

Background Nowadays, more than 90% of all rectal cancers can now be treated with a sphincter-preserving resection by specialized surgeons without impairment of the oncological radicality. However, postoperatively functional disorders such as fecal incontinence, urgency, and frequent bowel movements are common, which are referred to as low anterior resection syndrome (LARS) and which have a significant impact on quality of life. Thus, in addition to tumor follow-up, the detection and treatment of functional disorders are essential. Objectives The main aspects of follow-up care and treatment of LARS are discussed. Materials and methods Relevant studies were selected and further research based on its reference lists was undertaken. Results Up to 80% of patients develop LARS after sphincter-preserving rectal resection. A detailed medical history and physical examination including endoscopic assessment of the anastomosis are essential for assessing LARS. Furthermore, validated questionnaires should be also used. Therapy is mostly conservative (medication, pelvic floor exercises +/- biofeedback, transanal irrigation). Sacral nerve modulation is mainly used as a surgical option. Permanent colostomy can be useful as an ultima ratio. In addition to a neuroprotective dissection, a neorectal reservoir should be created to prevent or minimize LARS. Conclusions While tumor follow-up care guidelines for rectal cancer are already been established, no standardized follow-up care or treatment concepts exist for LARS. In addition to preventive surgical strategies (neorectal reservoir), early postoperative detection and initiation of therapy adapted to severity of functional disorders is crucial for minimizing LARS.