Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1804527
Review Article

Low Anterior Resection Syndrome, Role of SNM?

Franco Marinello
1   Hospital Universitari Vall d'Hebrón, Universitat Auntònoma de Barcelona, Barcelona, Spain
› Institutsangaben

Abstract

Low anterior resection syndrome (LARS) includes all bowel dysfunctions after rectal cancer surgery, causing significant damage to survivors' quality of life. Among different therapeutical approaches, sacral neuromodulation (SNM) has become an interesting technique to palliate LARS symptoms. This article highlights the pathophysiology of LARS, describing the most important aspects of SNM in this scenario.



Publikationsverlauf

Artikel online veröffentlicht:
20. Februar 2025

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  • References

  • 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
  • 2 Siegel RL, Fedewa SA, Anderson WF. et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst 2017; 109 (08) djw322
  • 3 Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg 1998; 133 (08) 894-899
  • 4 Arnold M, Rutherford MJ, Bardot A. et al. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol 2019; 20 (11) 1493-1505
  • 5 Pieniowski EHA, Nordenvall C, Palmer G. et al. Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study. BJS Open 2020; 4 (05) 935-942
  • 6 Keane C, Fearnhead NS, Bordeianou LG. et al; LARS International Collaborative Group. International consensus definition of low anterior resection syndrome. Dis Colon Rectum 2020; 63 (03) 274-284
  • 7 Bryant CLC, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol 2012; 13 (09) e403-e408
  • 8 Lee WY, Takahashi T, Pappas T, Mantyh CR, Ludwig KA. Surgical autonomic denervation results in altered colonic motility: an explanation for low anterior resection syndrome?. Surgery 2008; 143 (06) 778-783
  • 9 Keane C, Sharma P, Yuan L, Bissett I, O'Grady G. Impact of temporary ileostomy on long-term quality of life and bowel function: a systematic review and meta-analysis. ANZ J Surg 2020; 90 (05) 687-692
  • 10 Kim MJ, Park JW, Lee MA. et al. Two dominant patterns of low anterior resection syndrome and their effects on patients' quality of life. Sci Rep 2021; 11 (01) 3538
  • 11 Varghese C, Wells CI, Bissett IP, O'Grady G, Keane C. The role of colonic motility in low anterior resection syndrome. Front Oncol 2022; 12: 975386
  • 12 McDermott FD. Altered colonic motility is associated with low anterior resection syndrome, by Keane et al. Colorectal Dis 2021; 23 (02) 338
  • 13 Asnong A, Tack J, Devoogdt N, De Groef A, Geraerts I, D'Hoore A. Exploring the pathophysiology of LARS after low anterior resection for rectal cancer with high-resolution colon manometry. Neurogastroenterol Motil 2022; 34 (11) e14432
  • 14 Marinello F, Pellino G, Espín-Basany E. Low anterior resection syndrome: an unavoidable price to pay to preserve the rectum?. Front Oncol 2022; 12: 994720
  • 15 Asnong A, D'Hoore A, Van Kampen M. et al. The role of pelvic floor muscle training on low anterior resection syndrome a multicenter randomized controlled trial. Ann Surg 2022; 276 (05) 761-768
  • 16 Marinello FG, Jiménez LM, Talavera E. et al. Percutaneous tibial nerve stimulation in patients with severe low anterior resection syndrome: randomized clinical trial. Br J Surg 2021; 108 (04) 380-387
  • 17 Pieniowski EHA, Bergström CM, Nordenvall CAM. et al. A randomized controlled clinical trial of transanal irrigation versus conservative treatment in patients with low anterior resection syndrome after rectal cancer surgery. Ann Surg 2023; 277 (01) 30-37
  • 18 Cardozo L, Rovner E, Wagg A, Wein A, Abrams P. eds. Incontinence 7th Edition. 7th International Consultation on Incontinence. International Continence Society; 2023
  • 19 De Wachter S, Knowles CH, Elterman DS. et al. New technologies and applications in sacral neuromodulation: an update. Adv Ther 2020; 37 (02) 637-643
  • 20 Matzel KE, Stadelmaier U, Bittorf B, Hohenfellner M, Hohenberger W. Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int J Colorectal Dis 2002; 17 (06) 430-434
  • 21 Ratto C, Grillo E, Parello A, Petrolino M, Costamagna G, Doglietto GB. Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon Rectum 2005; 48 (05) 1027-1036
  • 22 Pires M, Severo M, Lopes A, Neves S, Matzel K, Povo A. Sacral neuromodulation for low anterior resection syndrome: current status—a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38 (01) 189
  • 23 Marinello F, Fraccalvieri D, Planellas P. et al. Sacral neuromodulation in patients with low anterior resection syndrome: the SANLARS randomized clinical trial. Dis Colon Rectum 2024; 67 (03) 435-447
  • 24 Lin AY, Dinning PG, Milne T, Bissett IP, O'Grady G. The “rectosigmoid brake”: review of an emerging neuromodulation target for colorectal functional disorders. Clin Exp Pharmacol Physiol 2017; 44 (07) 719-728
  • 25 Patton V, Wiklendt L, Arkwright JW, Lubowski DZ, Dinning PG. The effect of sacral nerve stimulation on distal colonic motility in patients with faecal incontinence. Br J Surg 2013; 100 (07) 959-968
  • 26 Matzel KE, Chartier-Kastler E, Knowles CH. et al. Sacral neuromodulation: standardized electrode placement technique. Neuromodulation 2017; 20 (08) 816-824
  • 27 Christensen P, Im Baeten C, Espín-Basany E. et al; MANUEL Project Working Group. Management guidelines for low anterior resection syndrome—the MANUEL project. Colorectal Dis 2021; 23 (02) 461-475