Late complications and functional disorders after rectal resection. Prevention, detection and therapy

The prognosis of patients with rectal carcinoma has been improved with the implementation of multimodal therapy and improvement of the surgical technique. Therefore, late complications and functional consequences that determine the quality of life following oncological rectal resection are increasingly being recognized. In general both the surgical trauma and side effects of the multimodal therapy play a critical role in the manifestation of various problems in the long-term course after treatment of rectal carcinoma. In this context the low anterior resection syndrome (LARS) has been described which is influenced by different factors and can be worsened by neoadjuvant radiation. Disorders of the urinary bladder and sexual dysfunction as well as benign anastomotic stenoses are problems independent of LARS. Therapeutic approaches for these late complications and functional disorders have either been insufficiently evaluated or are not available. Treatment of functional disorders can be attempted by pelvic floor training, biofeedback and sacral nerve stimulation. Interventional and surgical procedures are available to treat anastomotic stenosis. It must be emphasized that an adequate surgical technique is indispensable to avoid most of these late complications and functional disorders.