Das Low anterior Resection Syndrome (LARS)

Zusammenfassung

Hintergrund Mit einem 5-Jahres-Überleben von mittlerweile 80% rückt die postoperative Lebensqualität nach onkologischer Rektumresektion zunehmend in den Fokus des Interesses. Das Low anterior Resection Syndrome (LARS) fasst die postoperative Morbidität infolge des operativen Eingriffes zusammen.

Material und Methode Es wurde eine selektive Literaturrecherche durchgeführt, um das Bild des LARS näher zu definieren und Verständnis für seine Pathophysiologie, Diagnose, Therapie und Prophylaxe zu entwickeln.

Ergebnisse LARS wird in bis zu 80% nach allen stomavermeidenden operativen Eingriffen beobachtet, die beim Rektumkarzinom durchgeführt werden. Die Kapazität des Rektumstumpfes wie auch die Verletzung nervaler Strukturen scheinen die wichtigsten pathogenetischen Faktoren zu sein, die zu einer signifikanten Einschränkung der Lebensqualität führen.

Schlussfolgerungen Es existieren verschiedene therapeutische Ansätze, um die Konsequenzen des LARS beim einzelnen Patienten abzuschwächen. Nichtsdestotrotz wird in der Zukunft noch viel Arbeit notwendig sein, um nicht nur das Überleben, sondern auch die Lebensqualität nach einem Rektumkarzinom zu verbessern.

Abstract

Background As 5-year survival after rectal cancer surgery has reached 80%, there is increasing interest in quality of life. Low anterior resection syndrome (LARS) is an overall measure of the postoperative functional disorder due to the surgical resection.

Material and Methods A thorough review of the literature was undertaken to help to define LARS and develop an understanding of its pathophysiology, diagnosis, therapy, and prophylaxis.

Results LARS is observed after up to 80% of stoma sparing procedures performed for rectal carcinoma. The capacity of the rectal remnant as well as intraoperative damage to neuronal structures seem to be the most important pathogenetic factors resulting in a substantial impairment of the quality of life. Pelvic floor rehabilitation, rectal balloon distension training, biofeedback, anal irrigation, and sacral nerve stimulation are multimodal treatment options for LARS.

Conclusions Various therapeutic approaches exist to attenuate the consequences of LARS for the individual patient. Nevertheless, considerable work has to be done in the future not only to improve survival but also the quality of live after rectal carcinoma.

Schlüsselwörter

Low anterior Resection Syndrome (LARS) - Rektumkarzinom - Lebensqualität - anorektale Pathophysiologie

Key words

low anterior resection syndrome (LARS) - rectal cancer - quality of life - anorectal pathophysiology

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